Association of common mental disorders and quality of life with the frequency of attendance in Slovenian family medicine practices: longitudinal study.
BACKGROUND
Most research on frequent attendance has been cross-sectional and restricted to one year attendance rates. A few longitudinal studies suggest that frequent attendance is self-limiting. Frequent attenders are more likely to have social and psychiatric problems, medically unexplained physical symptoms, chronic somatic diseases (especially diabetes) and are prescribed more psychotropic medication and analgesics.


OBJECTIVE
To describe the attendance rates in a longitudinal study and to test if depression, panic syndrome, other anxiety syndrome, alcohol misuse and general quality of life are associated with frequent attendance in next two consecutive years.


METHODS
1118 consecutive family practice attendees, aged 18 to 75 years from randomly selected family medicine practices were recruited at baseline and followed up at 12 and 24 months. We identified frequent attenders in the top 10 centile within one year. Using a multivariate model, we ascertained if presence of common mental disorders and quality of life assessed at baseline in 2003 predict frequent attendance in 2004 and 2005.


RESULTS
40% of frequent attenders continue to be frequent attenders in the following year and 20% of the frequent attenders were so for the 24 month period. Lower physical scores on the SF-12 questionnaire were strongly associated with future frequent attendance at 12 and 24 months. There was a trend for people with greater than elementary school education to be less likely to become frequent attenders at both 12 and 24 months. For other variables these effects were less consistent. Presence of major depression, panic syndrome, other anxiety syndrome and alcohol misuse were not predictive of frequent attendance in the following two years.


CONCLUSIONS
Low physical quality of life is strongly predictive of higher frequent attendance and similar finding was observed for people with lower educational level but further confirmatory research is required to establish this association.
Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. janez.rifel@mf.uni-lj.si
Janez
J
Rifel
Igor
I
Svab
Polona
P
Selič
Danica
D
Rotar Pavlič
Irwin
I
Nazareth
Josip
J
Car
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders; D003865:Major Depressive Disorder; D004522:Educational Status; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D016584:Panic Disorder; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D055815:Young Adult