The course of psychological symptoms and the initial management strategies in primary care

Asma Chaabouni

Keywords: psychological symptoms, primary care, electronic health records

Background:

Psychological symptoms in primary care are common. It is unknown how these symptoms evolve

Research questions:

What is the course of psychological symptoms?
What are the management strategies during the first year of care for psychological symptoms that persisted for more than a year and those that evolved into psychiatric conditions?

Method:

We performed a retrospective longitudinal cohort study using the Family Medicine Network (FaMe-Net) database. We included all Episodes of Care (EoC) that started with a psychological symptom diagnosis between 2008 and 2021. We performed descriptive statistics to explore the course of each EoC and logistic regression analyses to evaluate management strategies highly associated with symptoms evolving into psychiatric conditions and symptoms evolving into persistent psychological symptoms

Results:

Out of the 14,633 included episodes, 12.8% evolved into persistent psychological symptoms and 7.8% evolved into psychiatric conditions. Out of all EoC, only 4.5% were referred to psychiatrists. Sleep disturbance (42%) and feeling anxious (24.2%) were the most common psychological symptoms that evolved into psychiatric conditions and persisted respectively. A higher number of contacts with the GP (RR = 1.15, 95% CI [1.10, 1.20]), types of interventions (RR = 1.02, 95%CI [ 1.00, 1.03]), contact with a mental health nurse (OR= 3.26, 95%CI [1.96, 5.41), and a lower number of different medications (RR = 0. 77, 95%CI [0.60, 0.99]) were highly associated with symptoms that evolved into psychiatric conditions compared to those that persisted.

Conclusions:

In primary care, a considerable number of psychological symptoms persist and only a few evolve into a psychiatric disease. Future research should focus on developing management strategies for psychological symptoms, specific to primary care, as most of these episodes are managed in primary care.

Points for discussion:

#21