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Cited by 216Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research Topics

Outcome of Depression and Anxiety in Primary Care: A Three-Wave 31/2-Year Study of Psychopathology and Disability

Ormel, Johan·1993·Archives of General Psychiatry
DOI 10.1001/archpsyc.1993.01820220009001
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Abstract

BACKGROUND: We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n = 201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability. METHODS: A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n = 292) with differing probabilities was selected for second-stage interview (Present State Examination and Groningen Disability Schedule). Patients with psychiatric symptoms (n = 201) were reassessed 1 (n = 182) and 3 1/2 (n = 154) years later. RESULTS: At 1- and 3 1/2-year follow-ups, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety and mixed anxiety-depression. CONCLUSIONS: We concluded that a multicategorical, rather than a binary, outcome measure better reflects patient outcomes, since it highlights partial remission, mild symptoms, and residual disability, and as such, stresses the need to supplement short-term treatment. A multicategorical caseness model may be advantageous for research and clinical practice. We suggest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the recognition, treatment, and 1-year course of common psychiatric illnesses in general practice.

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Authors
Ormel, J.
Affiliations
University of Groningen (NL)
Corresponding author
Ormel, Johan
ORCID
Ormel, Johan
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1993-10-01
Volume
50
Issue
10
Pages
759
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.1993.01820220009001
OpenAlex
W1971621926
Cited by
216
References
46
Citations by year
2026: 1 · 2025: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 5
FWCI
15.77
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords
depression, anxiety, mixed anxiety-depressive disorder, long-term outcomes, disability, partial remission, residual symptoms, primary care, general practitioners, mental health screening, General Health Questionnaire, Present State Examination, dynamic equilibrium model
MeSH terms
Adaptation, Psychological, Adolescent, Adult, Aged, Anxiety Disorders, Cross-Sectional Studies, Depressive Disorder, Family Practice, Female, Follow-Up Studies, Humans, Male, Middle Aged, Primary Health Care, Psychiatric Status Rating Scales, Severity of Illness Index, Social Adjustment, Treatment Outcome

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