Andrew Gracy, Cohen Alex, Salgaonkar Shruti, Patel Vikram
Sangath, Goa, India.
BMC Res Notes. 2012 Sep 12;5:499. doi: 10.1186/1756-0500-5-499.
The biggest barrier to treatment of common mental disorders in primary care settings is low recognition among health care providers. This study attempts to explore the explanatory models of common mental disorders (CMD) with the goal of identifying how they could help in improving the recognition, leading to effective treatment in primary care.
The paper describes findings of a cross sectional qualitative study nested within a large randomized controlled trial (the Manas trial). Semi structured interviews were conducted with 117 primary health care attendees (30 males and 87 females) suffering from CMD. Main findings of the study are that somatic phenomena were by far the most frequent presenting problems; however, psychological phenomena were relatively easily elicited on probing. Somatic phenomena were located within a biopsychosocial framework, and a substantial proportion of informants used the psychological construct of 'tension' or 'worry' to label their illness, but did not consider themselves as suffering from a 'mental disorder'. Very few gender differences were observed in the descriptions of symptoms but at the same time the pattern of adverse life events and social difficulties varied across gender.
Our study demonstrates how people present their illness through somatic complaints but clearly link their illness to their psychosocial world. However they do not associate their illness to a 'mental disorder' and this is an important phenomenon that needs to be recognized in management of CMD in primary settings. Our study also elicits important gender differences in the experience of CMD.
基层医疗环境中常见精神障碍治疗的最大障碍是医疗服务提供者的低识别率。本研究试图探索常见精神障碍（CMD）的解释模型，目的是确定它们如何有助于提高识别率，从而在基层医疗中实现有效治疗。
本文描述了一项嵌套在大型随机对照试验（玛纳斯试验）中的横断面定性研究的结果。对117名患有CMD的基层医疗就诊者（30名男性和87名女性）进行了半结构化访谈。该研究的主要发现是，躯体现象是迄今为止最常见的就诊问题；然而，在深入询问时，心理现象相对容易被引出。躯体现象处于生物心理社会框架内，相当一部分受访者用“紧张”或“担忧”的心理概念来描述他们的疾病，但并不认为自己患有“精神障碍”。在症状描述中观察到的性别差异很少，但同时不良生活事件和社会困难的模式因性别而异。
我们的研究表明了人们如何通过躯体主诉来呈现他们的疾病，但又清楚地将他们的疾病与心理社会世界联系起来。然而，他们并不将自己的疾病与“精神障碍”联系起来，这是在基层医疗环境中管理CMD时需要认识到的一个重要现象。我们的研究还揭示了CMD经历中重要的性别差异。
