title: Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care.
abstract: BACKGROUND
  The aim of the present study was to determine the prevalence of somatization, anxiety, depression and stress in a primary care population, explore their association to psychosocial stressors and determine the diagnostic overlap of these four mental disorders.
  
  
  METHODS
  This is a prospective cross-sectional study. A representative sample of 2,150 patients was approached, of whom 1,762 patients agreed to participate and responded to the questionnaire (81.9%). Anxiety was assessed with the Generalized Anxiety Disorder Scale (GAD-7). Depression was assessed with the depression module Patients Health Questionnaire-8. Somatization was measured with the somatic symptom module PHQ-15. The Perceived Stress Scale (PSS) instrument was used to identify the stress cases.
  
  
  RESULTS
  Of the study sample, 23.8% of the total cases were identified as probable cases. The prevalence of somatization, depression, anxiety and stress was 11.7%, 11.3%, 8.3% and 18.6%, respectively. The specific gender prevalence of these four psychological disorders was very similar in men and women: depression (11.3% versus 11.3%), anxiety (7.7% versus 8.9%), somatization (12.5% versus 10.7%) and stress disorders (19.3% versus 17.8%). A significant difference was observed in nationality and marital status for depression and anxiety (P < 0.05). The age-specific prevalence rate showed a higher prevalence in the age group 45-54 years: depression (13.3%), anxiety (9.5%), somatization (12.8%) and stress (20.4%). Unable to control worries (69.2%) was the worst symptom for anxiety disorders, while the majority of the depressed patients wanted to hurt themselves (71.9%). Stomach pain (46.1%) was the most common symptom in somatic patients. Most of the patients experiencing stress could not cope with their daily duties (65.9%). There was a high comorbidity rate of depression, anxiety, somatization and stress observed in the studied population (9.3%).
  
  
  CONCLUSIONS
  The prevalence of somatization and depression was similar, but the prevalence of stress was higher in inpatient patients. Somatization, depression, anxiety and stress disorders co-occurred at higher rate in the study sample.
authors.affiliation: Department of Medical Statistics and Epidemiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. abb2007@qatar-med.cornell.edu
authors.forename: Abdulbari
authors.initials: A
authors.lastname: Bener
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Kazaz
authors.forename: Darine
authors.initials: D
authors.lastname: Ftouni
authors.forename: Munjid
authors.initials: M
authors.lastname: Al-Harthy
authors.forename: Elnour E
authors.initials: EE
authors.lastname: Dafeeah
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D018912:Arabs / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011780:Qatar / Q000453:epidemiology; D012494:Sampling Studies; D017678:Sex Distribution; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology
keywords: Arab population; anxiety; depression; somatization; stress