Psychological assessment in Primary Care: A comparison of different strategies

Introduction: Primary Care Psychologists make use of psychiatric classifications for the assessment of patients in general practice. However, customary psychiatric diagnoses, such as the DSM category of somatic symptoms and related disorders (SSD), have shown limited clinical utility in medical settings. There is currently need to develop and evaluate alternative assessment strategies to appropriately characterize psychosocial factors in primary care. Aims: The aim of this study was to evaluate the incremental information provided by the Diagnostic Criteria for Psychosomatic Research (DCPR), in addition to the DSM-5 and compared to the SSD, in primary care. Methods: Two hundred participants, recruited in a primary care practice, were administered the Structured Clinical Interview for DSM-5, the Structured Interview for DCPR revised and Paykel's Clinical Interview for Depression. Subjects also completed the Short Form Health Survey, the Psychosocial Index and the Illness Attitude Scales. Sub-groups comparisons and hierarchical regression analyses were performed to evaluate the associations of DCPR and DSM-5 diagnoses with psychological measures. Results: DCPR identified psychological distress in the proportion of 4:1 as compared to the SSD. The percentage of patients with at least 1 diagnosis rose from 23%, when using solely the DSM-5, to 46% when integrating the DCPR. The DCPR showed a greater number of significant predictions of dimensional measures of quality of life, well-being, stress, psychological distress and illness behavior, compared to SSD. Psychosomatic syndromes had a large effect size over and above that of DSM-5. Conclusions: The DCPR are superior to the SSD in evaluating psychosocial factors in primary care patients. Integration of DCPR in the psychological assessment in primary care enhances the clinical utility of the DSM-5.