Abstract
Background
Studies have shown a high worldwide prevalence of mental disorders in primary care. Many patients present with unexplained physical symptoms rather than psychological complaints, resulting in an excess number of costly clinical investigations. This study investigates the ability of primary care physicians to correctly detect and diagnose somatization and depression in Saudi Arabian patients.
Methods
In all 431 primary care patients in Riyadh Saudi Arabia were screened for somatization and depression using the Patient Health Questionnaire (PHQ). Primary care physicians independently assessed these same patients while blinded to the results of the PHQ. Agreement between physician observations and the screening instrument was examined.
Results
Using the PHQ as the standard of comparison for measuring the detection rates of Saudi physicians, the agreement between and the PHQ and physician assessments was κ=0.40 for depression (0.45 females, 0.31 males) and κ=0.27 for somatization (0.36 females, 0.12 males). Physicians assessed higher rates of somatization than indicated by the screening instrument and demonstrated poor diagnostic agreement on somatization and depression, particularly for male patients.
Conclusions
Saudi primary care physicians have awareness of psychiatric disorders, but their diagnostic skills are poor for somatization and depression. Psychiatric training should be supported in the continuing education of primary care physicians and patients should be encouraged to report psychological complaints to family physicians. A simple screening instrument for identifying mental disorders in developing countries is a valuable tool for assessment in primary care.
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References
Escobar JI, Burnam A (1987) Somatization in the community. Arch Gen Psychiatry 44:713–718
Goldberg D (1995) Epidemiology of Mental Disorders in Primary Care. Epidemiologic Rev 17:182–188
Escobar JI, Gara M, Silver RC (1998) Somatization Disorder in Primary Care. Br J Psychiatry 173:262–266
Katon W (1998) Medically unexplained symptoms in Primary Care. J Clin Psychiatry 59:15–21
Gureje O, Simon G (1997) Somatiztion in Cross Cultural Perspective. A World Health Organization Study in Primary Care. Am J Psychiatry 154:989–995
De Gucht V, Fischler B (2002) Somatization: A Critical Review of Conceptual and Methodological Issues. Psychosomatics 431:1–9
Al Faris E, Al Hamid A (1995) Hidden and Conspicuous Psychiatric Morbidity in Saudi Primary Health Care. Arab J Psychiatry 6(2):162–175
Becker S, Al Zaid K, Al Faris E (2002) Screening for Somatization and Depression in Saudi Arabia. Int J Psychiatry Med 323:271–283
Al Faris E, Towards A (1998) Campaign to Combat psychological Disorders in the Community. Ann Saudi Med 83:205–207
Racy J (1980) Somatization and Saudi Women. Br J Psychiatry 137:175–180
Spitzer R, Kroenke K, Williams J (1999) Validation and Utility of a Self Report Version of the PRIME MD. The PHQ Primary Care Study. J Am Med Assoc 282(18):1737–1744
Narrow W, Rae D (2002) Revised Prevalence Estimates of Mental Disorders in the United States. Arch Gen Psychiatry 52:115–123
American Psychiatric Association (2000) Diagnostic and Statistical Manual IV-TR. Washington D. C.
Rief W, Joerg H (1996) The classification of Multiple Somatoform Symptoms. J Nerv Ment Dis 184:680–687
Lipowski ZL (1988) Somatization: The Concept and Its Clinical Application. Am J Psychiatry 145:1358–1368
Lipowski Zl (1990) Somatization and Depression. Psychosomatics 31:13–21
Escobar J, Rubio-Saipec M (1989) Somatic Symptom Index. A New and Abridged Somatization Construct. J Nerv Ment Dis 177(3):140–146
Kronke K, Spritzer RL, deGruy F, Hahn S, Linzer M, Williams J (1997) Multisomatoform Disorder.An Alternative to Undifferentiated somatoform Disorder for the Patient in Primary Care. Arch Gen Psychiatry 544:352–356
Spitzer R, Williams J, Kroenke K (1994) Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME MD 1000 Study. J Am Med Assoc 272:1749–1756
Cohen J (1996) Coefficient of agreement for nominal scales. Educational and Psychological Measurements 20:37–46
Mezzich JE, Jorge M, Salloum I (1994) Psychiatric Epidemiology: Assessment Concepts and Methods. Johns Hopkins University Press, Baltimore Maryland
Spitzer R, Williams J (2000) Validity and Utility of PHQ in Assessment of 3000 OB-GYN Patients. Am J Obstetr Gynecol 183(3):759–769
Kroenke K, Spitzer R (1994) Physical Symptoms in Primary Care. Archives of Family Medicine (3):774–779
Bass C, Peveler R, House A (2001) Somatoform Disorders: Severe Psychiatric Illnesses Neglected by Psychiatrists. Br J Psychiatry 179:11–14
Ormel J, Von Korff,Ustun TB (1994) Common Mental Disorders and Disability Across Cultures. J Am Med Assoc 272:1741–1748
Gilbody S, House A, Sheldon S (2001) Routinely Administered Questionnaires for Depression and Anxiety: A Systematic Review. Br Med J 322:406–409
Fink P, Sorensen L, Engberg N (1999) Somatization in Primary Care. Prevalence, Health Care Utiliztion, and General Practitioner Recognition. Psychosomatics 40:330–338
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Becker, S.M. Detection of somatization and depression in primary care in Saudi Arabia. Soc Psychiatry Psychiatr Epidemiol 39, 962–966 (2004). https://doi.org/10.1007/s00127-004-0835-4
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DOI: https://doi.org/10.1007/s00127-004-0835-4