OUTCOME OF DEPRESSION AND ANXIETY IN PRIMARY-CARE - A 3-WAVE 3 1 2-YEAR STUDY OF PSYCHOPATHOLOGY AND DISABILITY/

Background: We evaluated the long-term outcome of depression and anxie ty and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n=201) using binary and multicateg orical, interview-based outcome measures of psychiatric illness and di sability. Methods: A two-stage design was used. In the first stage, 19 94 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n=292) with differing probabi lities was selected for second-stage interview (Present State Examinat ion and Groningen Disability Schedule). Patients with psychiatric symp toms (n=201) were reassessed 1 (n=182) and 31/2 (n=154) years later. R esults: At 1- and 31/2-year follow-ups, many cases no longer met the c riteria of their baseline diagnosis and disability levels had substant ially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had bett er outcomes than anxiety and mixed anxiety-depression. Conclusions: We concluded that a multicategorical, rather than a binary, outcome meas ure better reflects patient outcomes, since it highlights partial remi ssion, mild symptoms, and residual disability, and as such, stresses t he need to supplement short-term treatment. A multicategorical casenes s model may be advantageous for research and clinical practice. We sug gest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the re cognition, treatment, and 1-year course of common psychiatric illnesse s in general practice.