A decade of spontaneous long-term course of psychogenic impairment in a community population sample

Background Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorder s (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal a dult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample ov er a long period remains largely unknown. Method: Beginning in 1979 (n(t1) = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (n (t3) = 301). The follow-up sample was representative of the tl sample. Psyc hodynamically trained and clinically experienced interviewers used a semi-s tructured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Im pairment Score, IS). Results: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, I CD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of ps ychogenic impairment between tl and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relev ant psychogenic impairment. Within a regression model clinical variables, c hildhood development conditions and personality traits at t1 predicted psyc hogenic impairment at t3. Conclusion: All clinical variables conclusively i ndicate an unfavorable spontaneous long-term course of psychogenic impairme nt. Together with the well-known high prevalence of psychogenic disorders i n the normal population, this underlines the need for early therapeutic and preventive intervention.