STABILITY OF PSYCHIATRIC SYMPTOMS IN PRIMARY CARE PTS

初级保健医生越来越担心DSM系统不能准确反映初级保健中出现的心理健康问题。 初级保健患者经常被他们的初级保健医生判断为心理痛苦和功能受损;但他们不符合DSM精神障碍标准。 然而，使用DSM系统的研究被引用为证据，表明初级保健医生未能认识到心理健康问题，没有最佳地治疗他们认识到的问题，并需要将这些患者转诊给心理健康专业人员。 本试点研究的目的是测试的方法和估计所需的统计参数进行纵向初级保健为基础的研究，评估的准确性和临床有效性的DSM分类系统在初级保健设置。 这项研究将使用三种后续策略来衡量招募和辍学率。 它还将确定定性访谈的最佳时间，以及是否存在基于基线“痛苦”的差异。 这项基于初级保健的纵向试点研究将在6个月内随访100名西班牙裔和非西班牙裔白色患者。 排除使用改良的SCID筛选模块的DSM疾病患者或基线时使用精神药物的患者，将对50名在慢性医学问题数量上匹配的抑郁患者和50名非抑郁患者进行基线评估，包括简明社会期望量表。 基线和每月访谈将包括通过SCID识别常见DSM疾病，通过SCL-R测量焦虑、抑郁和躯体化水平，通过GHQ-12评估痛苦，评估近期急性疾病，使用SF-36测量功能状态，使用Holmes和Rahe量表和日常麻烦量表识别生活压力，分别通过Herth Hope Index和DUSOCS测量希望和支持，并通过AUDIT评估酒精使用情况。 每月将使用三种后续策略之一进行后续访谈。此外，还将进行16次均衡的定性访谈，以确定最佳访谈时间并评估定量评估的有效性。 时间关系的分析将依赖于潜在增长曲线分析。 此外，该研究还将确定哪种随访策略的随访率最高，以及基线“痛苦”是否是重要的入选标准。 这项试点研究还将通过访谈方法评估反应偏差，分类阈值对应的心理学水平，以及社会期望和随时间变化之间的关系。

There is growing concern among primary care physicians that the DSM system does not accurately reflect mental health problems seen in primary care. Primary care patients are frequently judged by their primary care physician to be psychologically distressed and functionally impaired; yet they do not meet DSM criteria for a mental disorder. However, studies using the DSM system are cited as evidence that primary care physicians fail to recognize mental health problems, do not optimally treat those they recognize, and need to refer such patients to mental health professionals. The purpose of this pilot study is to test the methods and estimate statistical parameters needed for conducting a longitudinal primary care-based study assessing the accuracy and clinical validity of the DSM classification system in primary care settings. This study will measure recruitment and dropout rates using three follow-up strategies. It will also determine optimal timing for qualitative interviews and whether there are differences based upon baseline "distress". This longitudinal primary care based pilot study will follow 100 Hispanic and non-Hispanic white patients over a 6-month period. Excluding patients with DSM disorders using a modified SCID screening module or those on psychotropics at baseline, 50 distressed and 50 non-distressed patients matched on the number of chronic medical problems will undergo baseline assessment including the Brief Social Desirability Scale. Baseline and monthly interviews will include identification of common DSM disorders via the SCID, measurement of levels of anxiety, depression, and somatization via the SCL-R, assessment of distress via the GHQ-12, assessment of recent acute illnesses, measurement of functional status using the SF-36, identification of life stresses using the Holmes and Rahe scale and the Daily Hassles Scale, measurement of hope and support via the Herth Hope Index and the DUSOCS respectively, and assessment of alcohol use via the AUDIT. Monthly follow-up interviews will occur using one of three follow-up strategies. Additionally, 16 balanced qualitative interviews will be performed to determine optimal timing of interviews and assess validity of quantitative assessments. Analysis of temporal relationships will rely upon latent growth curve analysis. In addition, the study will identify which follow-up strategy produces the highest follow-up rate and whether baseline "distress" is an important inclusion criterion. This pilot study will also assess response bias via method of interview, levels of symptomatology corresponding to classification thresholds, and the relationship between social desirability and variation over time.