Outcome and impact of mental disorders in primary care at 5 years.
OBJECTIVE
To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care.


METHODS
A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up.


RESULTS
At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%).


CONCLUSIONS
Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.
Jackson
Jeffrey L
JL
Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
Passamonti
Mark
M
Kroenke
Kurt
K
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D018450:Disease Progression; D004219:District of Columbia / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010045:Outpatients / Q000706:statistics & numerical data*; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology; D017060:Patient Satisfaction; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires