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Research Transfer > System-Linked Research Unit Working Paper Series #97-12
   

97-12

System-Linked Research Unit
Working Paper Series #97-12

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

ABSTRACT

Background
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.

Objective
This study sought to determine the 12 month co-morbid prevalence of Axis I psychiatric disorders in a primary care Health Service Back to TopOrganization in Southern Ontario.

Design/Measures
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 Back to TopBrowne Health and Social Services Utilization Questionnaire.

Results/Discussion
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 Back to Toporganization.

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