anxiety disorders, panic disorder, obsessive-compulsive disorder, phobias, post-traumatic stress disorder

A short report in the July issue of the British Journal of Psychiatry reveals that the longer the duration of untreated symptoms of common mental illnesses, the worse the psychiatric outcome is.

Studies on the duration of untreated symptoms focus on time to hospital admission for severe mental illnesses, such as schizophrenia, rather than on common mental disorders in primary care.

This international study from Canada investigated the effect of duration of untreated symptoms on 1-year outcome in primary care, using data from the 1990-1993 World Health Organisation Collaboration Study of Psychological Problems in General Health Care. Data were available for Ankara, Athens, Bangalore, Groningen, Ibadan, Manchester, Rio de Janeiro, Santiago, Seattle and Verona.

Patients aged between 16 and 65 who had not visited their primary care doctor in the last 3 months were screened for psychiatric problems. Duration of untreated symptoms was assessed.

At the start of the study, the family doctor completed a questionnaire on the presence of psychiatric disorder in each patient, and any treatment offered.

All patients with significant psychological problems, and a 20% random sample of people who were not mentally unwell, were contacted for 12-month follow-up. 1791 patients were successfully followed up.

900 patients had not previously visited their general practice for their problem, and 351 were found to have a psychiatric illness. The majority had depression.

73% were women or girls; 81.9% had a low educational level; 40.7% were single; and 21.4% were unemployed. The average duration of untreated symptoms was 19 weeks.

Patients averaged 5 visits to their general practice, and 3 to other clinics. 12% had been admitted to hospital at least once.

The duration of untreated symptoms showed a significant association with overall psychiatric symptoms 1 year later, as did initial psychiatric symptom count, older age, lower educational levels, medically unexplained physical symptoms, and visits to the doctor.

The duration of untreated symptoms also showed an association with anxiety symptoms and depression.

The authors of the study conclude that the outcome and response to treatment for common psychological disorders, such as depression and anxiety, are inversely proportional to their duration.

One explanation is that inadequate treatment leads to persistence of symptoms, and collaboration between specialists and family doctors can help to address this. The authors suggest another explanation i.e. longer waits for treatment.

These results support the 'kindling' hypothesis of anxiety and depression, in which the association between episodes and adverse life events weakens with successive illnesses, suggesting biological or psychological adaptation, so that psychological factors are no longer necessary for relapse.

Kisely S, Scott A, Denney J, Simon G.
Duration of untreated symptoms in common mental disorders: association with outcomes: International study.
Br J Psychiatry. 2006 Jul;189:79-80.   [Abstract]