GENDER, QUALITY-OF-LIFE, AND MENTAL-DISORDERS IN PRIMARY-CARE - RESULTS FROM THE PRIME-MD-1000 STUDY

BACKGROUND: Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 stud y to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these d ifferences on health-related quality of life (HRQL). SUBJECTS AND METH ODS: One thousand primary care patients (559 women) were interviewed d uring the PRIME-MD study, which was conducted at four primary care cli nics affiliated with university hospitals throughout the eastern Unite d States. Patients completed a one-page questionnaire in the waiting r oom prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R a lgorithms to diagnose mood, anxiety, somatoform, eating, and alcohol r elated disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey. RESULTS: Women we re more likely than men to have at least one mental disorder (43% vers us 33%, P <0.05). Higher rates were particularly prominent for mood di sorders (31% of women versus 19% of men, odds ratio [OR] = 1.9, 95% co nfidence interval [CI] 1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more comm on in women (26% of women had two or more mental disorders versus 15% of men, P <0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men l eg, physical function = 67 in women versus 76 in men, P <0.0001; menta l health = 69 in women versus 76 in men, P <0.0001). Many HRQL differe nces persisted after controlling for age, education, ethnicity, marita l status, and number of physical disorders; however, differences in HR QL were eliminated in 5 of 6 domains after controlling for number of m ental disorders. When compared with female patients of male physicians , female patients of female physicians demonstrated similar satisfacti on with care, health care utilization, HRQL, and recognition rate of m ental disorders. CONCLUSIONS: In the 1,000 patients of the PRIME-MD st udy, mood, anxiety, and somatoform disorders and psychiatric comorbidi ty were all significantly more common in women than men. The HRQL scor es were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. Th ese data suggest that one of the most important aspects of a primary c are physician's care of female patients is to screen for and treat com mon mental disorders. (C) 1996 Excerpta Medica, Inc.