Presence of Comorbid Somatic Disorders Among Patients Referred to Mental Health Care in the Netherlands

Abstract

Objective: Referral to mental health care was examined among persons with mental disorders with and without comorbid somatic conditions to determine whether certain conditions may make detection of mental disorders by primary care physicians more or less likely. Methods: Receipt of mental health care in the primary and specialty care settings by respondents to the Netherlands Mental Health Survey and Incidence Study who had mood disorders (N=573), anxiety disorders (N=912), and substance use disorders (N=533) was examined, first broadly by any of 31 somatic conditions and then by each of the five most common conditions. Results: Broadly, those with anxiety disorders and a somatic condition were more likely to use care in both settings (adjusted relative risk ratios [RRRs]=1.75 and 1.58 for primary and specialty care, respectively), and those with substance use disorders and a somatic condition were more likely to use specialty care (RRR=2.15). More narrowly, use of specialty care by persons with mood disorders was three times as likely for those with rheumatoid arthritis or a digestive tract disorder (RRRs=3.04 and 2.92). For anxiety disorders, specialty care was more likely for those with chronic backache (RRR=2.14) or a digestive tract disorder (RRR=3.56). For substance use disorders, those with chronic backache were six times as likely to use specialty care (RRR=6.05) and those with a digestive tract disorder were three times as likely (RRR=3.09). Conclusions: Poor somatic health in general seemed to increase the likelihood of use of mental health care for persons with anxiety or substance use disorders, but not for those with mood disorders. Having certain somatic conditions appeared to enhance recognition and treatment of three common mental disorders.