Common Mental Disorders in Primary Care
Also known as: Common mental distress · SRQ framework · Minor psychiatric morbidity
Framework that treats anxious, depressive and bodily complaints as one field rather than as separate diagnoses. It came out of the World Health Organization's collaborative study on extending mental health care through primary care, which found in four developing countries that roughly one patient in seven arrived with a mental disorder and that two thirds of those went unnoticed by the staff seeing them. The response was to stop asking which disorder and start asking whether there is distress at all, in language a general health worker could use without specialist training. Two consequences follow from that design. Bodily complaints belong in the measure rather than beside it, because in most of the world distress arrives as headaches, poor sleep and a bad stomach before it arrives as a mood word. And there is no universal threshold: what counts as a probable case depends on the language, the population and what the screening is for, so a number here is a position on a continuum of distress, never a diagnosis.
- Source:
- Harding, T. W., de Arango, M. V., Baltazar, J., Climent, C. E., Ibrahim, H. H. A., Ladrido-Ignacio, L., Murthy, R. S., & Wig, N. N. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine, 10(2), 231-241. Beusenberg, M., & Orley, J. (compilers) (1994). A User's Guide to the Self Reporting Questionnaire (SRQ). Geneva: World Health Organization. WHO/MNH/PSF/94.8.
Constructs
Common Mental Distress
Non-psychotic distress read as one field rather than sorted into diagnoses: low mood, worry and tension, and the bodily complaints that usually arrive with them (headaches, poor sleep, poor appetite, a bad stomach, shaking hands, tiredness that does not lift). The construct exists because in general health care the two halves show up together and separating them costs more information than it buys. It is a state tied to a recent window, not a trait, and it has no universal threshold: how many complaints amount to a probable case depends on the language, the population and what the screening is for.
Instruments
- Self Reporting Questionnaire, 20 items(SRQ-20)Harding, T. W., et al. (development, 1980); Beusenberg, M., & Orley, J. (compilers of the user's guide, 1994); World Health Organization1994