The effect of physical ill health on the course of psychiatric disorder in general practice

The aim of this study was to determine the effect of physical morbidity on the outcome of patients with psychiatric disorder, and to compare the effects on non-medically and medically explained symptoms.

One hundred and fifty psychiatric cases were recruited using a two-stage design from 1620 consecutive patients attending their GP. Subjects were assessed at the time of screening, and one year subsequently, using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from GPs.

Medically explained somatic symptoms were strongly related to psychological outcome one year later. Whereas just over a half of patients with no medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 41% in those with 1-4 medically explained symptoms, and only 21% in patients with five or more medically explained symptoms.

Physical ill-health has been shown to make an independent contribution to psychological outcome. The specific needs of these patients should receive greater attention.