Conditions not attributable to a mental disorder in Dutch psychiatric out-patients

According to DSM-III-R V-code conditions refer to marital relationships, family circumstances, interpersonal relationships, or stressful life events that are not attributable to a mental disorder but that are the focus of treatment. The purpose of the present study was to assess the prevalence and patient and treatment characteristics of adult psychiatric out-patients diagnosed with V-code conditions.

The records of all 5660 consecutive admissions to a psychiatric out-patient clinic over a 12-year period were studied retrospectively. On the basis of both primary and secondary DSM-III-R diagnoses on Axis I, two subgroups of patients were compared: (1) patients with V-code conditions; and (2) patients with mental disorders.

Fourteen per cent of the patients had a V-code condition and no mental disorder, while the remaining patients were diagnosed with mental disorder (with or without an additional V-code condition). Comparisons of sociodemographic and clinical severity characteristics of the two groups indicated that patients with V-code conditions tended to have a higher socio-economic status and to present with less severe problems as assessed both by the primary therapist and the Symptom-Checklist-90. With respect to service use and treatment outcome variables, it appeared that V-code patients tended to be more frequently treated by couple/family therapy and to receive a slightly lower number of treatment sessions.

The pattern of results in The Netherlands seems comparable to results of previous North American studies. Implications of these findings for future studies and for use of mental health services are discussed.