Mental disorders in primary care in Israel: prevalence and risk factors

Prevalence of mental disorders among middle-aged population of primary healthcare centers in Northeastern Iran

BACKGROUND

Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders.

METHODS

This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22.

RESULTS

This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant.

CONCLUSIONS

Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.

Effect of implementation of mental health services within primary care on GP detection and treatment of mental disorders in Israel

BACKGROUND

Psychiatric morbidity is frequent in primary care, but a substantial proportion of these psychiatric problems appear to be neither recognized nor adequately treated by GPs. There exists a number of models of introduction of mental health services (MHS) into primary care, but little data are available on their effect on GPs' detection or management of mental disorders. The study aimed to measure the effect of referring patients to a psychiatrist within primary care (Shifted OutPatient model-SOP) or consultation of psychiatrists by the GPs (Psychiatric Community Consultation Liaison-PCCL) on the detection and treatment of mental disorders by GPs.

METHODS

In six primary care clinics in Israel (three "SOP clinics" and three "PCCL clinics"), GP detection of mental disorders and treatment of GP-detected cases were evaluated before and after provision of 1-year MHS, according to GP questionnaires on a sample of primary care consecutive attenders whose psychological distress was determined according to the GHQ12 and psychiatric disorders according to the Composite International Diagnostic Interview.

RESULTS

After model implementation, a significant reduction in detection of mental disorders was found in SOP clinics, while no significant change was found in PCCL clinics. No significant change in detection of distress was found in any clinic. An increase in referrals to MHS for GP-diagnosed depression and anxiety cases, a reduction in GP counselling for GP-detected cases and those with diagnosed anxiety, an increased prescription of antidepressants and a reduced prescription of antipsychotics were found in SOP clinics. In PCCL clinics, no significant changes in GP management were observed except an increase in referral of GP-diagnosed depression cases to MHS.

CONCLUSIONS

MHS models did not improve GP detection of mental disorders or distress, but possibly improved referral case mix. The SOP model might have a deskilling influence on GPs, resulting from less involvement in treatment, with decrease of detection and counselling. This should be taken into consideration when planning to increase referrals to a psychiatrist within primary care settings. Lack of positive effect of the PCCL model might be overcome by more intensive programs incorporating educational components.

Prevalence of Mental Disorders in Uganda: a Systematic Review and Meta-Analysis

This systematic review was conducted to determine the prevalence of mental disorders among children and adults in Uganda. A comprehensive systematic search for relevant studies reporting prevalence of mental disorders in children or adults in Uganda was conducted in PubMed, Embase, PsycINFO, Scopus, Web of Science databases and grey literature sources. Study was eligible if, validated instrument based on the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders criteria to assess a mental disorder was used. Eligible studies were critically appraised, prevalence data extracted and pooled using the random-effects model. Certainty in the pooled prevalence estimates was evaluated using the Grading of Recommendation, Assessment, Development and Evaluation approach. A total of 632 records were obtained, of which 26 articles from 24 studies conducted in Uganda were included in the review. Overall and with moderate level of certainty, the prevalence of any mental disorder in Uganda was 22.9% (95% C.I 11.0% - 34.9%) in children and 24.2% (95% C.I 19.8% - 28.6%) in adults. Prevalence of anxiety disorders was 14.4% (95% C.I 4.9% - 24.0%) in children and 20.2% (95% C.I 14.5% - 25.9%) in adults. The prevalence of current depressive disorders was 22.2% (95% C.I 9.2% - 35.2%) in children and 21.2% (95% C.I 16.8% - 25.6%) in adults. Eating disorder and psychotic syndrome disorder were also reported. Our findings suggest that depression and anxiety disorders are common mental disorders in Uganda, affecting approximately one in four persons. The findings provide essential insights for health service planning, clinical practice, and future epidemiological research in Uganda.

Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia: a cross-sectional study

BACKGROUND

Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders.

METHODS

A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP).

RESULTS

Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%.

CONCLUSIONS

High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.

Somatoform disorders and medically unexplained symptoms in primary care

BACKGROUND

The literature contains variable figures on the prevalence of somatoform disorders and medically unexplained symptoms in primary care.

METHODS

The pertinent literature up to July 2014 was retrieved by a systematic search in the PubMed/MEDLINE, PsychInfo, Scopus, and Cochrane databases. The methodological quality and heterogeneity (I2) of the retrieved trials were analyzed. The prevalence rates of medically unexplained symptoms, somatoform disorders, and their subcategories were estimated, along with corresponding 95% confidence intervals (CI), with the aid of random-effects modeling.

RESULTS

From a total of 992 identified publications, 32 studies from 24 countries involving a total of 70 085 patients (age range, 15-95 years) were selected for further analysis. All had been carried out between 1990 and 2012. The primary studies were more heterogeneous overall; point prevalences for the strict diagnosis of a somatization disorder ranged from 0.8% (95% CI 0.3-1.4%, I2 = 86%) to 5.9% (95% CI 2.4-9.4%, I2 = 96%), with higher estimated prevalences in studies that applied less restrictive diagnostic criteria. At least one type of somatoform disorder was diagnosable by DSM-IV and/or ICD-10 criteria in a fraction of primary-care patients that ranged from 26.2% (95% CI 19.1-33.3%, I2 = 98%) to 34.8% (95% CI 26.6-44.6%; I2 = 92%). The percentage of patients complaining of at least one medically unexplained symptom ranged from 40.2% (95% CI 0.9-79.4%; I2 = 98%) to 49% (95% CI 18-79.8%, I2 = 98%). The quality of the studies, in general, was only moderate. No relationship was found between study quality and prevalence estimates.

CONCLUSION

The statistical heterogeneity of the included studies is very high. Somatoform disorders and medically unexplained symptoms are more common than generally assumed. The found prevalences highlight the importance of these conditions in primary care.

Characterization of depression among patients at urban primary healthcare centers in Oman

AIM

The aim of this study was to estimate the prevalence and predictors of depression among Oman adult population attending primary healthcare clinics (PHCs) in Muscat Governorate in 2011.

METHODOLOGY

A cross-sectional study was conducted on 2005 participants attending 27 different PHCs in Muscat Governorate during 2011. A Patient Health Questionnaire (PHQ-9), together with a socio-demographic and relevant clinical data questionnaire was administered.

RESULTS

Of the 2005 participants, 61.8% were women and 42.1% were of 25-50 age group. Of the total, 44.4% were employed, of whom 51% were government employees. The prevalence of depression among them was 8.1%. The adjusted odds ratios generated by logistic regression models indicated that depression was significantly associated with age greater than 50 years old (OR = 2.23; 95% CI 1.07, 4.22; P = 0.04), female (OR = 1.34; 95% CI 1.12, 3.82; P = 0.03), married (OR = 1.91; 95% CI 1.11, 3.30; P = 0.02), graduated or attended higher education (OR = 1.40; 95% CI 1.03, 2.66; P = 0.04), working in the private sector if employed (OR = 1.72; 95% CI 1.08, 2.75; P = 0.02), and having chronic illness such as diabetes mellitus, hypertension, asthma, heart, thyroid, and renal diseases (OR = 1.82; 95% CI 1.03, 3.51; P = 0.01).

CONCLUSION

The rate of depression appears to be in the lower range compared to rate reported from elsewhere. Some socio-cultural factors that may contribute to the present findings are discussed.

Between modern and traditional values: Informal mental health help-seeking attitudes according to Israeli Arab women, primary care patients and their providers

BACKGROUND

Israeli Arab women under-utilize mental health services.

OBJECTIVES

The present study evaluated the use of alternative services for dealing with depression and anxiety among Israeli Arab women and primary care providers.

MATERIAL

Four focus groups with primary care patients and two focus groups with primary care providers were conducted. Constant comparisons were employed in order to identify major themes related to informal help-seeking behaviors.

DISCUSSION

Three informal help-seeking behaviors were identified: (a) social support, divided into extended family and neighbors versus nuclear family and close friends; (b) religiosity, divided into inner, direct practices and beliefs versus externally mediated ones; and (c) self-help techniques, such as engagement in activities and distancing oneself from the situation. Both social support and religiosity were viewed with ambivalence by primary care patients and providers.

CONCLUSION

The findings suggest that the Arab population in Israel might be lacking informal sources of support at times of mental health needs.

The prevalence and burden of psychiatric disorders in primary health care visits in qatar: too little time?

BACKGROUND

Psychiatric disorders including anxiety, depression, somatization, obsessive compulsive, and bipolar disorders are recognized as causing the biggest burden of disease worldwide.

AIM

In this study, we aimed to assess the prevalence and burden of common mental disorders at Primary Health Care Centers (PHCC) using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) in the Qatari population, aged 18-65 who attended Primary Health Care (PHC) settings.

DESIGN

A prospective cross-sectional study conducted during November 2011 to October 2012.

SETTING

Primary Health Care Centers of the Supreme Council of Health, Qatar.

SUBJECTS

A total of 2,000 Qatari subjects aged 18-65 years were approached; 1475 (73.3%) agreed to participate.

METHODS

Prevalence and severity of International Classification of Disease-10 disorders were assessed with the WHO-CIDI (Version 3.0).

RESULTS

Of the 1475 participants, 830 (56.3%) were females and 645 (43.7%) was males. One-third were aged 35-49 years 558 (37.8%). The three most common disorders were major depression disorders (18.31%), any anxiety disorders (17.3%), any mood disorders (16.95%), followed by separation anxiety disorders (15.25%), personality disorder (14.1%). In the present study, prevalence in women was significantly higher than men for the most common psychiatric disorders, specifically generalized anxiety disorder, panic disorder, social phobia, specific phobias, obsessive compulsive disorders, posttraumatic disorder, somatization, major depressive disorder, bipolar disorder, dysthymia, and oppositional defiant disorder. Of the total 20% had only one psychiatric diagnosis and 12% had two disorders, 9.7% respondents with three diagnoses, and finally 4.3% of respondents had four or more diagnoses.

CONCLUSION

One-fifth of all adults who attended the PHCC (20%) had at least one psychiatric diagnosis. The CIDI is a useful instrument for psychiatric diagnosis in community settings such as PHC clinics, clinical research and intervention studies. There is an urgent need to not only assess prevalence, but also risk factors, burden, treatment gaps and outcomes to obtain evidence for policy making.

Prevalence, types and comorbidity of mental disorders in a Kenyan primary health centre

PURPOSE

To estimate the prevalence, types and comorbidity of the most common mental disorders and the spread of suicide risk in a primary care practice in Kenya.

METHODS

This was a cross-sectional descriptive study. A total of 300 adult outpatients were randomly selected while they were consulting their general practitioner. The M.I.N.I. Plus interview five was used to diagnose psychiatric disorders and suicide risk.

RESULTS

Thus, 56.3 % of the sample (n = 169) presented one or more psychiatric disorders. The most prevalent disorders were Affective (39.0 %), Anxiety (31.3 %), and Somatoform (13.0 %). Regarding specific disorders, the most common were Major Depressive Disorder (26.3 %), Agoraphobia (16.7 %), Pain Disorder (12.5 %), Generalized Anxiety Disorder (9.3 %) and Bipolar Disorder (9 %). We found three cases of Bulimia Nervosa (1 %); 29.7 % had more than one current mental disorder. Suicide risk was present in 12.7 % of participants. No associations were identified between socio-demographic factors and the presence of mental disorder. Suicide risk was higher in women and in patients who came from slum areas. Gastric pain was positively associated with presence of mental disorder.

CONCLUSION

High prevalence of mental disorders and suicide risk calls for integrating mental health services in primary health care; in particular, this study highlights the importance of differentiating between specific types of mental disorders (which require different therapeutic approaches), and of diagnosing comorbidities.

Risk factors for mental disorders in patients with hypertensive intracerebral hemorrhage following neurosurgical treatment

BACKGROUND

Mental disorders are commonly observed among surgically treated patients with hypertensive intracerebral hemorrhage (HICH), leading to serious negative impacts on the patient's treatment, rehabilitation, and prognosis. The study aimed to establish the prevalence rates and risk factors for mental disorders following the surgical treatment of HICH.

METHODS

This was a prospective study. Surgically treated patients with HICH were assessed 6 months following surgical treatment. The sociodemographic data were obtained from each subject, and clinical characteristics were collected for each patient from his or her hospital records. Mental disorder-related risk factors were examined using unpaired t-tests for continuous variables and χ(2) for categorical data, respectively, followed by multiple logistic regression analysis.

RESULTS

A total of 96 patients were recruited for this study. The incidence of mental disorders following surgical treatment of HICH was 32.3%. Univariate analysis revealed that the occurrence of postoperative mental disorders was correlated with gender, income, social interaction, relationship between family members, hematoma localization, hematoma volume, preoperative Glasgow Coma Scale (GCS) score, surgical approach, Barthel Index, hospitalization time, and discharged patients' caregivers. Multivariate logistic regression analysis indicated that female patients, social barriers, surgical treatment with a craniotomy, and bad relationship between family members were the independent risk factors for mental disorders following surgical treatment of HICH.

CONCLUSIONS

Postoperative mental disorders in patients with HICH were more likely to occur in female patients and patients who faced social barriers, those who were treated with a craniotomy, and those who experienced bad relationships between their family members. More attention and supports should be provided to this group of patients.