Hidden and conspicuous psychiatric morbidity in Saudi primary health care : a pilot study

الملخص EN

Ob jective: To estimate the rate of hidden psychiatric morbidity (HPM) among the study population and to compare the assessment of the primary health care (PHC) physician with that of the psychiatrist.

Design; All patients seen on two weekly sessions were rated by a PHC physician according to a pre-designed 5-point severity rating scale and diagnostic classification.

One third of them, selected on the basis of systematic random sampling, were interviewed by a psychiatrist using the clinical interview schedule (CIS).

The same diagnostic and severity rating scales were filled by the psychiatrist.

Setting; A primary care centre in Riyadh, the capital of Saudi Arabia.

Participants-114 patients seen by the PHC physician and 38 of them interviewed by the psychiatrist.

Results: The hidden psychiatric morbidity (HPM) is high (31%), representing 67% of the total psychiatric morbidity (46%).

This is due to the low identification index of the physician (33%).

The higher the severity of the illness as rated by the PHC physician, the more likely to be a clinically significant psychiatric case.

On the other hand, the specificity (95%) and predictive value (86%) are high, i.e.

he is likely to be correct when he makes a positive diagnosis.

There is a significant difference in the ratings of the psychiatrist and the physician , ( McNamar's test, P < 0.01 ) and the agreement is low, (Cohen's Kappa = 0.26).

Psychiatric illness with somatic symptoms constituted the largest proportion of diagnostic categories as judged by the psychiatrist (31%.6%).

Patients labeled by the PC physician to have physical illness in a neurotic personality were usually missed psychiatric cases.