Mental Disorders Among Frequent Attenders in Primary Care

Abstract

Frequent attenders account for a large proportion of primary care (PC) contacts, referrals, and prescriptions. Psychosocial and emotional distress is related to the high use of health services. Few studies have focused on the association between mental disorders assessed using structured interviews and frequent use of PC services.The aim of this study was to determine the factors associated with frequent attendance at primary healthcare units, focusing specifically on mental disorders. A two-phase screening epidemiological study comparing frequent attenders and routine attenders in five primary health care units was designed. Three hundred eighteen frequent attenders and 203 patients who attended the same units on a routine basis were compared. Sociodemographic and clinical data were obtained from statistical records and medical charts. Patients with a total score equal or higher than 7 points on the General Health Questionnaire-28 (GHQ-28) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. All the scores obtained on the GHQ were statistically different in the two populations. Frequency of mental disorders also differed significantly between both groups, with somatoform and affective disorders being the most prevalent ICD-10 categories among frequent attenders. The presence of depressive disorders and somatoform disorders is the most powerful predictive factor for frequent attendance. High comorbidity was found among frequent attenders with somatoform disorder. Frequent attendance at primary healthcare units is associated with depressive and somatoform disorders. Psychiatric comorbidity could be a confounder, particularly because affective and somatoform disorders often overlap in PC patients.

Frequent attendance in family practice and common mental disorders in an open access health care system

“…However, Gili et al (2011) found that after adjusting for other ICD-10 psychiatric disorders, somatoform as well as depressive disorders remained associated with frequent attendance [21]. Another explanation for our finding could be the direct access to mental health care professionals in the open access fee-for-service system.…”

“…However, the association between somatoform disorders and FA is in keeping with a large body of evidence from elsewhere [20][21][22]. In fact it has recently been suggested that a redrawing of the diagnostic criteria for the category somatoform disorders is needed, focusing on its main attributes: somatic symptoms, excess concern with symptoms and illness and abnormal health care utilization [34].…”

“…Higher rates of FA are found in association with mental illness [11,[14][15][16][17][18][19], the likelihood of FA increasing with anxiety disorder by a factor of 1.14 in a multi-adjusted model [19]. FAs also have higher rates of depressive symptoms [15,16,20,21], as well as somatoform symptoms or disorders [20][21][22][23].…”

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

“…Psychological distress has shown to be common among patients with more frequent visits in general practice care. 26,27 Our hypothesis was that NCCP patients might utilize a substantial amount of health-care resources due to the lack of explanations for the chest pain.…”

The Unifying Concept of Illness Behavior

“…Frequent attenders in general medical practice showed significantly higher levels of psychological distress and more psychiatric disorders than routine attenders [14,15,39]. The prevalence of psychiatric comorbidity among frequent attenders was found to vary from 26.7 to 54%, with depressive and somatoform disorders as the most frequent diagnoses [39,40].…”