Psychosocial illness: Community, primary health care and individual perspectives

The aim of the thesis is to contribute to knowledge of (1) psychosocial illness in the population, (2) the prevalence and nature of psychosocial illness encountered in primary health care, and (3) encountered among persons with long-term illness. The data collected include the results of a questionnaire given to a population-based sample of 13 000 persons (20-84 years), a questionnaire given to general practitioners (GP) (N=199), and interviews with 30 persons with long-term illness and results of psychological testing of them (Sense of Coherence, SOC, and Karolinska Scales of Personality, KSP).

The GPs estimated that approximately one third of their patients in primary health care had problems that could be attributed to psychosocial causes. GPs with a psychosocial orientation, as well as female GPs generally, gave higher estimates of the proportion of patients suffering from psychosocial illness. Pain, fatigue and multiple symptoms were the most frequently reported complaints, and loneliness, family problems and conflict at the work-place the most frequent psychosocial problems. A majority of the GPs felt that their medical training gave them inadequate knowledge of psychological and psychosocial issues. One third of the GPs considered their present level of education and experience to be insufficient to give patients with psychosocial problems adequate help.

A majority of the respondents in the population study considered their health and life-situation to be satisfactory. Health and living conditions were unequally distributed between groups, however. High-risk groups, defined as those with poor health and psychosocial problems, included persons with long-term illness, as well as unemployed persons, women, immigrants, single persons, low-educated persons, workers and farmers. The same high-risk groups were overrepresented on nearly all variables included in the study. Patients in primary health care reported a greater number of symptoms and of psychosocial problems than the remaining participants in the population sample did. A certain degree of correspondence was found between the symptoms and the psychosocial problems found in the population study and the GPs’ appraisal of their patients’ concerns.

The 30 persons with long-term illness who were interviewed reported that they had been exposed to various adverse conditions. Two thirds of them had experienced a harsh upbringing and had received only a minimal level of education. Half of the group had no vocational education at all and one fifth was unemployed. One third of the total group had been exposed to a variety of hardships concerning their health and their life situation. This subgroup had significantly lower SOC scores than the remaining individuals, as well as higher scores on somatic anxiety, muscular tension, psychasthenia and lower scores on socialization in terms of the KSP. A significant decrease in SOC scores was shown in a follow-up study six years later, indicating a continuous deterioration of the patients’ overall well-being.