THE PREVALENCE, CO-MORBIDITY AND COSTS
OF DYSTHYMIA IN PRIMARY CARE: UNDER RECOGNITION OF THE MIX OF PROBLEMS
Bell B, Browne G, Steiner M, Roberts J,
Gafni A, Byrne C,
Chalklin L, Mills M, Webb M, Jamieson E, Dunn E
Dysthymia can result in significant somatic, social and occupational
impairment for both the index patient and all members of a household.
This and other co-morbid disorders go unrecognized a significant
proportion of the time.
This study sought to determine the 12 month co-morbid prevalence
of Axis I psychiatric disorders in a primary care Health Service
in Southern Ontario.
A prospective analytic survey of 6280 adults between the ages of
18 and 75 years was conducted. Consenting adults were screened using
the University of Michigan Composite International Diagnostic Instrument
(UM-CIDI) short form for 9 mood disorders. Adults with any one of
9 mood disorders were asked to consent to a further interview with
the family physician who used the Structured Clinical Interview
for the Diagnosis of Non Patient Populations (SCID-NP) to confirm
the presence of dysthymia. Some 96.3% of eligible adults with dysthymia
consented to further interviews where they were administered sociodemographic
and health status questionnaires. These questionnaires were the
Montgomery Asberg Depression Rating Scale (MADRS), the Center for
Epidemiologic Studies Depression Scale (CES), the Weissman Social
Adjustment Scale (SAS), the Moos Coping Scale, the Offord Child
Behaviour Inventory and/or the Minnesota Child Development Inventory
and the Browne
Health and Social Services Utilization Questionnaire.
The prevalence of dysthymia was 5.1% in this primary care population,
suggesting that dysthymia is two times more prevalent in primary
care populations (5.0%) than in general populations (0.8% to 2.5%).
It is associated with significant costs in terms of poor health
status, concomitant mental disorder, ineffective patterns of coping,
poor social adjustment, family dysfunction and childhood disorder,
higher reliance on social assistance and use of health and social
services. Consistent with other studies, there is more of dysthymia
in the general medical than specialty mental health or psychiatric
clinics. This disorder in a primary care setting with a mental health
team is associated with greater use of general practitioner, social
worker, family therapist, psychologist and emergency room, unemployment
and social assistance services. Co-morbidity in adults with dysthymia
and their children may be more likely to go unrecognized in solo
practices without the advantages of the interdisciplinary and intergenerational
management of mental, behavioural and health disorders available
through a health service organization.