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Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care.

Method

Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25–75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two “other mental health disorders” (somatization and disordered eating) and five sub-threshold conditions.

Results

The most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had ‘other mental disorders’ and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45–64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and Jewish Israelis or between secular or religious sectors of the population.

Conclusions

This study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.

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Notes

  1. This refers to the Israeli sample in this international study [45].

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Acknowledgment

This research was supported by a grant from The National Institute for Health Policy and Health Services Research (# 83656101).

Author information

Authors and Affiliations

  1. Center for Women’s Health Studies and Promotion, Ben Gurion University of the Negev, POB 653, Beer Sheva, Israel, 84105

    Julie Cwikel PhD

  2. Falk Institute for Mental Health Studies, Jerusalem, Israel

    Nelly Zilber D.ès SC, Marjorie Feinson PhD & Yaacov Lerner MD

  3. French Research Center in Jerusalem, Jerusalem, Israel

    Nelly Zilber D.ès SC

Authors
  1. Julie Cwikel PhD
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  2. Nelly Zilber D.ès SC
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  3. Marjorie Feinson PhD
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  4. Yaacov Lerner MD
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Correspondence to Julie Cwikel PhD.

Appendix 1—Procedures for defining sub-threshold diagnoses

Appendix 1—Procedures for defining sub-threshold diagnoses

For depression, panic disorder and obsessive-compulsive disorder, the CIDI-SF algorithm does not give a precise cut-off point for diagnosis, but the probability to have a diagnosis for the different possible scores. The researchers decided that, for depression, a score of 4–7 (probability of 81–91%) would define a diagnosis and a score of 3 (probability of 55%) would define a sub-threshold diagnosis. For panic disorder, a score of 3–6 (probability of 87–100%) would define a diagnosis and a score of 2 (probability of 42%) would define a sub-threshold diagnosis. For OCD, a score of 3 (probability of 84%) would define a diagnosis. No sub-threshold diagnosis was defined since, for a score of 2 the probability is only 6.4%.

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Cwikel, J., Zilber, N., Feinson, M. et al. Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care. Soc Psychiat Epidemiol 43, 184–191 (2008). https://doi.org/10.1007/s00127-007-0286-9

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  • DOI: https://doi.org/10.1007/s00127-007-0286-9

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