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Lo studio internazionale multicentrico dell'Organizzazione Mondiale della Sanità sui disturbi psichici nella medicina generale: risultati relativi all'area di Verona1

Published online by Cambridge University Press:  07 August 2014

Marco Piccinelli ,
Stefano Pini ,
Cesario Bellantuono ,
Paola Bonizzato ,
Elisabetta Paltrinieri ,
T. Bedirhan Üstün ,
Norman Sartorius  and
Michele Tansella
Marco Piccinelli*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Stefano Pini
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Cesario Bellantuono
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Paola Bonizzato
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Elisabetta Paltrinieri
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
T. Bedirhan Üstün
Affiliation:
Division of Mental Health, World Health Organization, Geneva
Norman Sartorius
Affiliation:
Division of Mental Health, World Health Organization, Geneva
Michele Tansella
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dr. M. Piccinelli, Servizio di Psicologia Medica, Istituto di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax (+39) 45-585.871.
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Summary

Objectives - To present the results obtained from a cross-sectional evaluation of a sample of primary care attenders selected in Verona in the framework of the World Health Organization International Multicentre Study on Psychological Problems in Primary Care Settings. Methods - Among consecutive attenders at 16 primary care clinics in Verona during the period April 1991/February 1992, a random sample, stratified on the basis of GHQ-12 scores, was selected for a thorough evaluation of psychological status, physical status and disability in occupational and other daily activities. All patients with psychopathological symptoms at baseline assessment and a 20% random sample of those without psychopathological symptoms were interviewed again after 3 and 12 months (data not presented here). Results - Overall, 1,656 subjects were approached at the primary care clinics and 1,625 met inclusion criteria. The screening procedure was completed by 1,558 subjects and the second-stage evaluation by 250. Psychiatric disorders according to ICD-10 criteria were diagnosed in 12.4% of consecutive primary care attenders; of these, about one-third (4.5% of consecutive primary care attenders) satisfied ICD-10 diagnostic criteria for two or more disorders. Current Depressive Episode (4.7%) and Generalized Anxiety Disorder (3.7%) were the most common diagnoses. In addition, 11.2% of consecutive primary care attenders had ‘sub-threshold’ psychiatric disorders (i.e., they suffered from symptoms in at least two different areas among those listed in ICD-10, but they did not satisfy diagnostic criteria for well-defined disorders). Psychiatric disorders were more common among females and those aged 24-44 years. Only 20.6% of the subjects with psychiatric disorders contacted the general practitioner for their psychological symptoms, 5.7% complained of symptoms which might have had a psychological origin, whereas in about 70% of the cases the psychiatric disorder was concealed behind the presentation of somatic symptoms, pains in various parts of the body or chronic physical illness. Sixty-two percent of the subjects with psychiatric disorders rated their health status as fair or poor, as compared to 52.0% of those with chronic physical illness and 31.3% of those without such disorders. According to the general practitioner, 40.1% of the subjects with psychiatric disorders and 45.3% of those with chronic physical illness had a fair or poor health status, compared to 14.4% of those without such disorders. Disability in occupational and other daily activities was reported by 52.5% of the subjects with psychiatric disorders (in 40.1% of the cases disability was moderate or severe), 44.4% of those with chronic physical illness (in 26.8% of the cases disability was moderate or severe), and 15.0% of the subjects without such disorders (in 9.1% of the cases disability was moderate or severe). According to the interviewer, disability was identified in 48.4% of the subjects with psychiatric disorders, 39.0% of those with chronic physical illness, and 27.6% of the subjects without such disorders. Sixty per cent of the subjects with psychiatric disorders suffered from concurrent chronic physical illness; these subjects had a poorer health status and higher disability levels than those with psychiatric disorders only. Conclusions - Psychiatric disorders among primary care attenders are frequent and represents a major public health problem, since they entail severe functional limitations for the patients and high costs for the society. Thus, appropriate programs for their recognition and treatment are needed.

Keywords

primary health carepsychiatric disorderschronic diseasehealth statusdisability evaluationmedicina generaledisturbi psichicistato di salutedisabilità.
Type
Articoli
Information
Epidemiology and Psychiatric Sciences , Volume 4 , Issue 1 , Gennaio-Aprile 1995 , pp. 27 - 50
Copyright
Copyright © Cambridge University Press 1995

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Footnotes

(1)

Questo lavoro si basa sui dati raccolti nel corso del Progetto Psychological Problems in General Health Care Settings, che è stato coordinato dall'Organizzazione Mondiale della Sanità e finanziato dalla stessa e dai Centri partecipanti. I ricercatori responsabili del Progetto sono stati: Dr. N. Sartorius e Dr. T.B. Üstün, Division of Mental Health, WHO, Ginevra (Svizzera), Dr. O. Özturk e Dr. M. Rezaki, Ankara (Turchia), Dr. C. Stefanis e Dr. V. Mavreas, Atene (Grecia), Dr. S.M. Channabasavanna e Dr. T.G. Sriram, Bangalore (India), Dr. H. Helmchen e Dr. M. Linden, Berlino (Germania), Dr. W. van den Brink e Dr. B. Tiemens, Groningen (Olanda), Dr. M. Olatawura e Dr. O. Gureje, Ibadan (Nigeria), Dr. O. Benkert e Dr. W. Maier, Mainz (Germania), Dr. D. Goldberg e Dr. R. Gater, Manchester (Gran Bretagana), Dr. Y. Nakane e Dr. S. Michitsuji, Nagasaki (Giappone), Dr. Y. Lecrubier e Dr. P. Boyer, Parigi (Francia), Dr. J.A. Costa e Silva e Dr. L. Villano, Rio de Janeiro (Brasile), Dr. R. Florenzano e Dr. J. Acuna, Santiago del Cile (Cile), Dr. M. von Korff e Dr. G. Simon, Seattle (USA), Dr. Yan He-Qin e Dr. Xaio Shi Fu, Shangai (Cina), Dr. M. Tansella e Dr. C. Bellantuono, Verona (Italia). Un elenco completo dei ricercatori e del personale che ha fornito il proprio contributo durante lo svolgimento del Progetto è riportato nella monografia Mental Illness in Primary Care. An International Study (ed. N. Sartorius and T.B. Üstün), attualmente in stampa.

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