Background. Primary care attenders with a common mental
disorder (CMD) frequently present
with somatic symptoms. This study aimed to examine somatic and
psychological models of CMD
in primary care attenders in India.
Methods. Cross-sectional survey of attenders at two primary
care clinics. Psychiatric caseness was
determined on three criteria: standardized psychiatric interview
(biomedical criterion), patients'
self-assessment of emotional disorder (emic criterion) and health
care provider diagnosis. The
GHQ-12 and the PPQ, which emphasize psychological and somatic
symptoms respectively, were
used as screening instruments.
Results. Although somatic symptoms were the presenting
complaints for 97% of subjects, 51% of
subjects with a biomedically defined CMD had a psychological illness
attribution. Patients with
psychological attributions were more likely to be women, to have a
longer duration of illness, to
have higher CISR scores and were more likely to be recognized by
the primary health care (PHC)
physician. The GHQ-12 was superior to the PPQ in identifying cases
of CMD against the
biomedical criterion for both psychologizers and somatizers; both
instruments performed equally
well against the emic and care provider criteria.
Conclusions. Psychological models may be acquired by
patients as CMD becomes more chronic or
severe, making them more likely to be detected by PHC physicians.
Psychological symptoms are
superior to somatic symptoms in detecting CMD. Shorter versions of
the GHQ have comparable
discriminating abilities to the 12-item version and offer the
practical advantage of brevity, which may
make them more acceptable to PHC physicians as a clinical screening tool.