Patel V, Todd C, Winston M, Gwanzura F, Simunyu E, Acuda W, Mann A
Section of Epidemiology and General Practice, Institute of Psychiatry, London.
Br J Psychiatry. 1998 Jan;172:53-7. doi: 10.1192/bjp.172.1.53.
Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries.
Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n = 199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness.
The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation.
A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.
在低收入国家，初级保健就诊者中常见精神障碍（CMD）的结局鲜为人知。
对从津巴布韦哈拉雷的初级卫生保健机构、传统医学从业者诊所和全科医生诊所招募的一组CMD病例（n = 199）进行了2个月和12个月（T1和T2）的随访。采用绍纳症状问卷（SSQ）来衡量病例情况。
12个月时，41%的受试者病例水平的发病率持续存在。在两个随访点均接受访谈的134名受试者中，49%在T1时康复且在T2时仍保持良好状态，而28%在T1和T2时均为持续病例。较高的SSQ评分、心理疾病模型、丧亲之痛和残疾在两个时间点均预示着不良结局。仅在T1时不良结局与巫术因果模型和不幸福的童年有关。随访时的病例情况与残疾和经济贫困有关。
在12个月的随访期内，四分之一的CMD病例可能一直患病。针对结局不良的风险群体进行干预以及采取政策干预措施以减少经济贫困的影响，可能为低收入国家初级保健中应对CMD提供一种方法。
