Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients1,

https://doi.org/10.1016/j.apmr.2003.08.106Get rights and content

Abstract

Härter M, Woll S, Reuter K, Wunsch A, Bengel J. Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients. Arch Phys Med Rehabil 2004;85:1192–7.

Objective

To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs).

Design

Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews.

Setting

Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany.

Participants

More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed.

Interventions

Not applicable.

Main outcome measures

Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians.

Results

The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians’ diagnoses corresponded to the CIDI diagnoses.

Conclusions

The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.

Section snippets

Study design and sample

The study sample was taken from 10 rehabilitation hospitals in southwest Germany. Within a determined time period, all newly admitted patients were consecutively examined to minimize selection bias before screening.

The study protocol was designed to select 800 patients with the diagnosis of musculoskeletal disease and 800 patients with CVDs, for screening with the General Health Questionnaire (GHQ-12). Ten percent of low GHQ scorers, 30% of medium GHQ scorers, and 50% of high GHQ scorers were

Musculoskeletal diseases

A total of 672 patients with musculoskeletal diseases from 4 orthopedic rehabilitation hospitals filled in the set of questionnaires, and 205 were interviewed with the M-CIDI. One of the cooperating orthopedic rehabilitation hospitals also specializes in psychosomatic diseases. The interviewed patients had a mean age of 49 years (range, 22–75y). Seventy-four percent were still employed during the study period, and most (99%) were German citizens. The orthopedic diagnoses of the examined sample

Discussion

More than 31% of rehabilitation inpatients with musculoskeletal disorders and almost 20% of the patients with CVDs had current psychiatric symptoms.13 Considering the influences comorbid psychiatric disorders can have on QOL and rehabilitation outcome, it is important to learn to what extent psychologic problems are detected during rehabilitation. Furthermore, it is relevant to analyze the detection rate for assignment to psychosocial treatment.

Analysis of the discharge reports showed that only

Conclusions

Despite the limitations mentioned above, this study showed a need for improved diagnostics of mental disorders in medical rehabilitation. In particular, differential diagnostic skills need to be taught. The recognition of psychologic syndromes can be improved using the following course of action. First, all patients undergoing medical rehabilitation should be examined with brief screening scales during the first days of their inpatient treatment.46, 47 Second, it is important to choose adequate

Acknowledgements

We thank the following rehabilitation hospitals for their cooperation and their support in collecting the data: Theresienklinik, Bad Krozingen; Ziegelfeldklinik, St. Blasien; Schwarzwaldklinik, Bad Krozingen; Breisgauklinik, Bad Krozingen; Herz-Kreislauf-Klinik, Waldkirch; Klinik Baden, Bad Krozingen; Klinik Lazariterhof, Bad Krozingen; Rehabilitationsklinik Sinnighofen, Bad Krozingen; and Rheintal-Klinik, Bad Krozingen.

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    Supported by the Freiburg/Bad Säckingen Rehabilitation Research Network (grant nos. 01 GD 9802/4, 01 GD 0101), the Federal Ministry of Education and Research, and the Federation of German Pension Insurance Institutes.

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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