Psychiatric Morbidities among an Egyptian Sample of Patients attending Primary Health Care Outpatient Clinics

Abstract

Mental disorders affect a large percentage of population and constitute important cause of morbidity, mortality, and disability (Ormel et al., 2008).

Nevertheless, two-thirds of all patients with psychiatric disorders are seen exclusively in primary care settings. Thirty percent of all primary care patients meet DSM-IV-TR criteria for a psychiatric disorder, but many of these patients go underdiagnosed and missed by the primary care practitioners (PCPs) (Badamgarav et al., 2003). A number of reasons have been adduced for this. Patients seeing their primary care doctors tend to somatise their emotional distress, presenting with physical symptoms rather than overt psychological symptoms (Scicchitano et al., 1996). Medical history is often taken in conditions of little privacy thereby discouraging patients from sharing sensitive aspects of their distress (Goldberg, 1985). PCP may also not be confident in diagnosing and treating psychiatric disorders (Pini et al., 1997). Moreover, PCP tends to have limited time in which to obtain a psychiatric history (Spitzer et al., 1994).

The long-term consequences of psychiatric morbidity such as depression when it is not identified and treated can be severely harm the patient health and functioning. These include reduced quality of life, stigmatization, suicide, increased rates of hospital admission, loss of jobs and relationships, and deterioration in physical health including higher risk of myocardial infarction and chronic physical illnesses. Major depression is among the leading causes of disability-adjusted life-years worldwide. In addition, the economic burden of depression is considerable: in Canada alone, the estimated annual productivity losses owing to depression were $4.5 billion in 1998 (Joffres et al., 2013).

Concurrent physical illnesses increase the vulnerability to psychiatric disorders. On the other hand, psychiatric problems may decrease the adherence to medical treatments and lead to poorer health outcomes of the chronic diseases (Prakash et al., 2007).

The choice and effectiveness of intervention by primary care doctors for psychiatric morbidities can have a profound effect on the quality of life of the patients and the demand for services. However, many challenges exist in providing optimal care, including difficulties in recognizing patients with psychiatric morbidities, developing an adequate diagnostic initial assessment, implementing treatment and management strategies, and integrating care of psychiatric morbidities with that of co-existing chronic illnesses (Culpepper, 2002).