A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care

Psychother Psychosom. 2019;88(1):30-36. doi: 10.1159/000496477. Epub 2019 Feb 19.


Background: A number of studies have documented psychosocial problems, psychiatric morbidity and impaired quality of life in primary care patients.

Objective: The aim of this trial was to test the usefulness of the joint use of different diagnostic interviews and self-rated questionnaires.

Methods: Two hundred consecutive patients in a primary care practice in Italy underwent the Structured Clinical Interview for DSM-5 and the Semi-Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) in its recently revised form. As self-rated evaluations, the PsychoSocial Index, the Short-Form Health Survey and the Illness Attitude Scales were administered.

Results: There were 46 patients (23%) with at least 1 DSM-5 diagnosis. Eighty-eight patients (44%) had at least 1 DCPR diagnosis, mainly maladaptive illness behavior (26.5%), allostatic overload (15.5%) and demoralization (15%). There were 47 (23.5%) patients who had a DCPR diagnosis only; 5 subjects (2.5%) had a DSM diagnosis only. Patients with DCPR syndromes displayed significantly higher self-rated levels of stress, psychological distress and maladaptive illness behavior and significantly lower levels of quality of life and well-being than patients with no diagnoses.

Conclusions: In a busy clinical setting, a simple self-rated questionnaire such as the PsychoSocial Index may afford a useful tool to unveil patient current distress. The DCPR can provide clinical information for a substantial number of patients who do not satisfy DSM-5 classification criteria and yet present with psychosocial problems, as measured by self-rated scales. The DCPR may improve the assessment and treatment plan of primary care psychologists or consulting psychiatrists.

Keywords: Allostatic overload; Assessment; Demoralization; Illness behavior; Primary care; Primary care psychologist.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Diagnostic and Statistical Manual of Mental Disorders
  • Humans
  • Interview, Psychological / methods
  • Interview, Psychological / standards*
  • Italy
  • Mental Disorders / diagnosis*
  • Middle Aged
  • Primary Health Care / methods
  • Primary Health Care / standards*
  • Psychiatric Status Rating Scales / standards*
  • Self Report / standards*