Prevalence and 12-month outcome of threshold and subthreshold mental disorders in primary care

Background: The authors investigated the occurrence and 12-month outcome of mental disorders in primary care setting. Method: Out of 1555 primary care patients screened in an index period in 16 primary care clinics, 457 subje cts were selected for the second phase interview with the CIDI and 250 subj ects completed the assessment. Of these, 116 patients (49 ICD-IO cases and 67 subthreshold cases) completed the 12-month follow-up evaluation. Results : Overall, 12.4% of consecutive primary care attenders had a current ICD-10 disorder and 14.2% had a subthreshold mental disorder. Psychiatric comorbi dity was found in 45% of the initial sample. Physicians recognized the pres ence of a mental disorder at baseline in 84.6% of cases with depression com orbid with anxiety and in 44.8% of subthreshold cases. Subthreshold cases o utnumbered by three times threshold cases in terms of remission after one y ear. However, 18% of subthreshold conditions showed no improvement after 12 months. Recognition of mental disorder by the physician at baseline was no t associated with an improvement of psychopathology after 12 months, but wa s associated with an improvement in occupational disability and self-report ed disability among threshold cases. Conclusions: Mental disorders are freq uent in primary care but their outcome is relatively independent from recog nition by the physician. Threshold cases have a worse 12-month outcome than subthreshold cases. However, a substantial outcome variability seems to ch aracterize different diagnostic subgroups both in threshold and subthreshol d cases. (C) 1999 Elsevier Science B.V. All rights reserved.