Psychopathology in primary care patients: a four year study in rural and urban settings in Zimbabwe

Abstract

It has been argued that prevalence rates for psychopathology in Africa are stable over time and setting. There are, however, few longitudinal studies, and these conclusions are mainly based upon point prevalence studies. It has also been observed that African patients present with somatic symptoms, a feature argued to impede detection. Furthermore, it has been argued that such multiple somatic symptoms (three or more) are diagnostic of psychopathology. The present study examined these questions in the context of a longitudinal design. Prescriptive screenings of both rural and urban primary care patients were undertaken, and repeated the following year. The measures indicate that there is no significant difference in the rates in urban and rural settings, nor any difference in the rates over time. There were few differences between cases and non-cases in demographic characteristics, but there were differences in the clinical characteristics of the two groups. Cases tended to present with more symptoms than non-cases, thus corroborating earlier findings. In addition, the symptoms of cases tended to implicate more physiological systems than non-cases.

PIP: In Zimbabwe, medical students screened 1263 adults, 16-65 years old, attending general medical clinics at Howard Hospital in Chiweshe in 1986-87 and at the Parirenyatwa Primary Care Clinic in Harare in 1988-1989 for psychological disorders. 26% had a score of at least 7 on the self-reporting questionnaire (SRQ) 20, suggesting a psychological disorder. The prevalence of psychological disorder was somewhat higher among urban patients than rural patients, but the difference was not significant (28% vs. 24%; p = .09). Prevalence did not increase with time. The mean SRQ-20 score among cases fluctuated between 9.3 and 10.6 in 1986-1989. SRQ-20 scores for anxiety, depression, and suicidal ideation among cases were basically the same through out the study period. People with some degree of psychological disorder (cases) were more likely to be unemployed (p = 0.05). Cases had a higher number of complaints or symptoms than controls (p .001). They also had more psychological symptoms implicated by the complaints than did controls (p .001). Patient complaints may steer clinicians from examining patients for psychological disorders so that they just focus on physical illness. The researchers have identified a need to develop valid and reliable instruments for good descriptive studies, for longitudinal studies examining prevalence rates of psychopathology over time, and studies comparing psychopathology in different settings.