BOOK REVIEW. Mental Illness in General Health Care. An International Study

✍ Scribed by THOMAS BECKER; GRAHAM THORNICROFT

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 108 KB
• Volume: 11
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/(sici)1099-1166(199611)11:11<1021::aid-gps480>3.0.co;2-h

✦ Synopsis

The book presents the main findings of the crosssectional phase of WHO'S collaborative study on 'Psychological Problems in General Health Care'. The collaborating centres comprised eight centres in Europe, three centres each in Asia and the Americas, and one in Africa. The health care settings chosen for the study ranged from GP practices to public and private primary health centres of varying size. Follow-up results (at three and twelve months) will be reported elsewhere. There were marked differences across centres in prevalence rates for the Composite International Diagnostic Interview (CIDI) based 'psychological caseness' (ICD-10 diagnoses), the most common disorders being depression and generalized anxiety disorder. There was a clearcut effect of psychological 'caseness' on both self-and interviewer-rated disability which was independent of physical health. Psychological disorders had a strong and independent effect on health perception. Prevalence rates of ICD-10 psychological disorders vaned widely (rank orders being, however, consistent with both GHQ ratings and physicians' clinical diagnoses), ranging from 7.3% in Shanghai to 52.5% in Santiago de Chile with an average of 24% over all the centres. Prevalence rates were lowest in Asia, and highest in Europe and South America. The concordance of physicians' diagnoses with research diagnoses varied widely from 17% to 75%. Slightly less than half the patients considered to be 'psychological cases' by physicians did not fulfil ICD-10 diagnostic requirements. Concordance was higher in centres with an 'individualized care' model (physician known to patient and seeing him over time, easy access, appointment system, records kept by physician) as compared to a 'collective' or 'clinic-centered' care model