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A Three-Wave 31/2-Year Study of Psychopathology and Disability

Johan Ormel, PhD; Tineke Oldehinkel, MA; Els Brilman, MA; Wim vanden Brink, MD, PhD

Arch Gen Psychiatry. 1993;50(10):759-766.

Abstract
Background
We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n=201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability.

Methods
A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n=292) with differing probabilities was selected for second-stage interview (Present State Examination and Groningen Disability Schedule). Patients with psychiatric symptoms (n=201) were reassessed 1 (n=182) and 3 1/2 (n=154) years later.

Results
At 1- and 31/2-year follow-ups, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety and mixed anxietydepression.

Conclusions
We concluded that a multicategorical, rather than a binary, outcome measure better reflects patient outcomes, since it highlights partial remission, mild symptoms, and residual disability, and as such, stresses the need to supplement short-term treatment. A multicategorical caseness model may be advantageous for research and clinical practice. We suggest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the recognition, treatment, and 1-year course of common psychiatric illnesses in general practice.

Author Affiliations
From the Departments of Psychiatry (Drs Ormel and vanden Brink and Messrs Oldehinkel and Brilman) and Health Sciences (Dr Ormel), University of Groningen (the Netherlands).

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