A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care

Abstract

Background: A number of studies have documented psychosocial problems, psychiatric morbidity and impaired quality of life in primary care patients. Objective: The aim of this trial was to test the usefulness of the joint use of different diagnostic interviews and self-rated questionnaires. Methods: Two hundred consecutive patients in a primary care practice in Italy underwent the Structured Clinical Interview for DSM-5 and the Semi-Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) in its recently revised form. As self-rated evaluations, the PsychoSocial Index, the Short-Form Health Survey and the Illness Attitude Scales were administered. Results: There were 46 patients (23%) with at least 1 DSM-5 diagnosis. Eighty-eight patients (44%) had at least 1 DCPR diagnosis, mainly maladaptive illness behavior (26.5%), allostatic overload (15.5%) and demoralization (15%). There were 47 (23.5%) patients who had a DCPR diagnosis only; 5 subjects (2.5%) had a DSM diagnosis only. Patients with DCPR syndromes displayed significantly higher self-rated levels of stress, psychological distress and maladaptive illness behavior and significantly lower levels of quality of life and well-being than patients with no diagnoses. Conclusions: In a busy clinical setting, a simple self-rated questionnaire such as the PsychoSocial Index may afford a useful tool to unveil patient current distress. The DCPR can provide clinical information for a substantial number of patients who do not satisfy DSM-5 classification criteria and yet present with psychosocial problems, as measured by self-rated scales. The DCPR may improve the assessment and treatment plan of primary care psychologists or consulting psychiatrists.

The clinical utility of a comprehensive psychosomatic assessment in the program for colorectal cancer prevention: a cross-sectional study

“…Otherwise, studies in literature reported mostly mixed results concerning worry and anxiety among participants after receiving the result of positive fecal occulted blood test 45 , 46 . The findings of our investigation support the growing body of literature showing that DCPR criteria provide a better explanatory model for clinical phenomena in medical settings, which are not detected by traditional psychiatric nosography 32 , 47 . Moreover, Ferrari et al 48 underlined the clinical utility of DCPR in revealing patients with high psychological distress.…”

The Clinical Utility of A Comprehensive Psychosomatic Assessment in The Program for Colorectal Cancer Prevention: A Cross-Sectional Study

“…Otherwise, studies in literature reported mostly mixed results concerning worry and anxiety among participants after receiving the result of positive fecal occulted blood test [29,30]. The ndings of our investigation support the growing body of literature showing that DCPR criteria provide a better explanatory model for clinical phenomena in medical settings, which are not detected by traditional psychiatric nosography [31,32]. Moreover, Ferrari et al [33] underlined the clinical utility of DCPR in revealing patients with high psychological distress.…”

Allostatic Load and Its Impact on Health: A Systematic Review

“…Ex amples are provided by the posthospital syndrome, a pe riod of enhanced vulnerability to disease and to adverse events [305]; difficulties related to the process of recovery or rehabilitation [306]; and the cumulative longstanding chronic disease impairment [307]. In general, psychologi cal distress was reported in subjects displaying allostatic DOI: 10.1159/000510696 overload [276][277][278], which could also be linked to the onset and course of psychiatric disorders [297,308,309].…”

“…The clinimetric criteria for allostatic overload were able to discriminate the presence of psychological distress in another sample of the general population as well [277]. In a primary care setting [278], allostatic over load was the most frequently reported psychosomatic syndrome according to the DCPR [35]; it was associated with significantly greater psychological distress, lower wellbeing and impaired quality of life.…”