ผู้วิจัย/Authors: ชัชวาลย์ ศิลปกิจ

ชื่อเรื่อง/Title: Common Mental Disorder in Primary Care

แหล่งที่มา/Source: Mental Health & Psychiatric Annual Meeting 4, 7-9 September 1999

รายละเอียด / Details:

Objectives: 1) To investigate the prevalence of common mental disorder (CMD) in Thai primary care centres and factors associated with the disorders. 2) To investigate the detection rate of CMD by participating Thai primary care physicians and factors associated with detection. 3) To examine the effectiveness of providing primary care physicians with the results of a self-administered computerised assessment and management guidelines of CMD. Method: This study is consisted of two parts. Part one is a cross-sectional study. Consecutive primary care attenders in four primary care settings were screened by the This version of the General Health Questionnaire (GHQ) 12-item and one-third of those scoring above cut point were evaluated by the Revised Clinical Interview Schedule (CIS-R). Part two is an intervention study. Those attenders being identified as cases were allocated to control and experimental group. The experiment group performed a self-administered computerised assessment, the consulted their physicians with this assessment result which contained both diagnosis and management guidelines. Results: The results demonstrated that CMD are common in Thai primary care (45%). Factors associated with the disorder were low education, poor self-rated mental and physical health, higher degree of disability and more frequent number of previous visit. The diagnostic categories found in this study tend to differ from other published studies. Mixed anxiety and depressive disorder (MAD) (11%) and neurasthenia (6%) were more common than pure depressive disorder (1.6%) or anxiety disorders (4.0%). A low rate (27%) of case detection by primary car physician was confirmed. Patients who were likely to be detected were those scoring GHQ positive and being female. The physicians’ attitude that ‘Working with a psychiatric patient is heavy going’ was strongly correlated with lower detection rate. The intervention in Part II had no effect on patient clinical outcome but results were weakened by a low response rate at follow-up. However, the intervention did increase the physicians’ detection rate. The patients in experimental group received more antidepressant medication was prescribed for them. Conclusions and Implications: This study confirmed the high prevalence rate of CMD in primary care in Thailand but demonstrated that the distribution of diagnostic categories in Thai primary care differed from those reported from Western countries. The implications of this study especially for developing countries are there-fold. First, for undergraduatepsychiatric training, more attention should be to the less typical disorders such as mixed anxiety and depressive disorder. Primary car physicians should be later trained in detection and treatment of common mental disorders. Second, for health service system, planning of mental health services should be based on a country’s own epidemiological data. More studies will be needed in Thailand. Third, self-administered computerised assessment seemed to be feasible and helpful, therefore of potential benefit in busy primary care centers.

Keywords: CMD, community, GHQ, psychiatry, stress, ความเครียด, เครียด, จิตเวช, จิตเวชศาสตร์, ชุมชน

ปีที่เผยแพร่/Year: 1999

Address: Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University.

Code: 201410004086

ISSN/ISBN: -

Country of publication: Thailand.

Language: English.

Category: Paper.

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