Use of the PRIME-MD Patient Health Questionnaire for estimating the prevalence of psychiatric disorders in French primary care: comparison with family practitioner estimates and relationship to psychotropic medication use

Abstract

Objectives: The objectives of this study were to establish provisional psychiatric diagnoses using the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PHQ) and to describe family practitioner (FP) case recognition, survey-day prescription of anxiolytic and antidepressant medications and overall consumption rates (medication use).

Methods: Between October 2003 and April 2004, 1151 consecutive patients (> or = 18 years old) of 46 FPs practicing in and around the city of Montpellier, France, completed the PHQ. During the consultation, FPs rated the severity of any psychiatric disorder.

Results: PHQ prevalence rates (FP case recognition percentages are given in parentheses) were as follows: 10.9% (36%) for probable alcohol abuse/dependence; 11.3% (40%) for somatoform disorder; 9.1% (75%) for major depression; 7.4% (42%) for other depressive disorders; 7.5% (69%) for panic disorder; and 6% (69%) for other anxiety disorders. The prescription rate for all study patients was 11.3%, ranging from 6.2% for those without a PHQ disorder to 30.3% for those with a PHQ diagnosis of anxiety or depression to 48.2% for FP-recognized cases. The estimated survey-day consumption rate for these medications was 19.4%.

Conclusions: High consumption of anxiolytic and antidepressant medications in France is confirmed but not explained either by higher prevalence rates of psychiatric disorders as compared with other locations or by unusually high survey-day prescription rates. A possible explanation would be the organization of the French health care system, which has multiple sources for obtaining medication.