This proposal requests support for part of an international collaborative study organized by the World Health Organization (WHO) to examine psychologic distress, psychiatric disorder, and functional somatic symptoms in general health care settings. Support is specifically requested for a U.S. site to join existing sites in Europe, South America, Asia, and Africa. The overall project will examine level of psychiatric morbidity among primary care medical patients as well as the association of that morbidity with disability and use of health services. Use of standardized instruments and training will allow international comparisons not previously possible. The proposed Seattle site will also study the effects of patient psychological distress on physician decision-making as well as the relationship between reported and actual health services utilization. Study protocol calls for each site to screen 1500 primary care patients using the General Health Questionnaire (GHQ) and AUDIT questionnaire. A random sample of 395 respondents (stratified by GHQ score) will complete the Composite International Diagnostic Interview (CIDI). All interviewed subjects with significant psychiatric morbidity will complete 3- and 12-month follow-ups to assess symptom levels, disability, and use of health services.
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