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Subthreshold psychiatric symptoms in a primary care group practice
M Olfson1, W E Broadhead, M M Weissman
1Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Archives of General Psychiatry
|October 1, 1996
Summary
Subthreshold psychiatric symptoms are common in primary care and can cause significant impairment. Depressive and panic symptoms, in particular, remain disabling even after accounting for other factors, warranting broad assessment.
Area of Science:
- Psychiatry
- Primary Care Medicine
- Mental Health Research
Background:
- Subthreshold psychiatric symptoms, not meeting full diagnostic criteria, are prevalent in primary care.
- These symptoms are defined across six categories: depressive, anxiety, panic, obsessive-compulsive, drug, and alcohol use.
Purpose of the Study:
- To examine the clinical significance and impact of subthreshold psychiatric symptoms in an outpatient primary care setting.
- To determine if these symptoms are associated with functional impairment.
Main Methods:
- A study of 1001 adult primary care patients within a health maintenance organization.
- Data collected included sociodemographics, functional impairment (Sheehan Disability Scale), and a structured diagnostic interview for DSM-IV disorders.
Main Results:
- Subthreshold symptoms were frequently observed, sometimes exceeding the prevalence of full disorders.
- Patients with subthreshold symptoms reported significantly greater functional impairment.
- Depressive and panic symptoms demonstrated significant impairment even after adjusting for confounding factors.
Conclusions:
- While confounding factors often explain the morbidity of subthreshold symptoms, depressive and panic symptoms show independent disabling effects.
- Primary care clinicians should consider comprehensive psychiatric evaluations when subthreshold symptoms are identified.