A new evaluation strategy for assessing stress, allostatic load in primary care

A new evaluation strategy for assessing stress, allostatic load and distress has been found of clinical value in a trial in primary care published in the current issue of Psychotherapy and Psychosomatics. A number of studies have documented psychosocial problems, psychiatric morbidity and impaired quality of life in primary care patients.The aim of this trial was to test the usefulness of the joint use of different diagnostic interviews and self-rated questionnaires.

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 showed that 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.

In a busy clinical setting, a simple self-rated questionnaire such as the PsychoSocial Index may represent 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.