POSEIDON study: common mental disorders
Authors: Narayana Manjunatha, Santosh Kumar Chaturvedi
Journal: The Lancet Global Health (2016)

The POSEIDON study1Salvi S Apte K Madas S et al.Symptoms and medical conditions in 204 912 patients visiting primary health-care practitioners in India: a 1-day point prevalence study (the POSEIDON study).Lancet Glob Health. 2015; 3: e776-e784Summary Full Text Full Text PDF PubMed Scopus (49) Google Scholar by Sundeep Salvi and colleagues (December, 2015) assessed 1-day point prevalence of medical symptoms and diagnoses in patients who visited primary health-care practitioners across India. Overall, the study results were skewed towards respiratory disorders. We wish to highlight an important oversight in this study—ie, common mental disorders (a triad of depressive disorders, anxiety disorders, and somatoform disorders). Research findings have consistently shown that common mental disorders are present in up to 50% of patients who visit primary health-care practitioners in India,2Nambi SK Prasad J Singh D Abraham V Kuruvilla A Jacob KS Explanatory models and common mental disorders among patients with unexplained somatic symptoms attending a primary care facility in Tamil Nadu.Natl Med J India. 2002; 15: 331-335PubMed Google Scholar which is consistent with results worldwide.3Sansone RA Sansone LA Psychiatric disorders: a global look at facts and figures.Psychiatry. 2010; 7: 16-19Google Scholar The POSEIDON study did not report on common mental disorders for two possible reasons. First, the POSEIDON questionnaire underwent pilot testing of feasibility without psychometric evaluation. The two-page questionnaire did not include an option for common mental disorders (just one for “psychological disturbances”). Common mental disorders usually present in primary health-care settings as physical symptoms,4Weich S Lewis G Donmall R Mann A Somatic presentations of psychiatric morbidity in general practice.Br J Gen Pract. 1995; 45: 143-147PubMed Google Scholar which could have led to overestimation of physical illnesses in this study because general or unspecified physical symptoms were not identified as symptoms of common mental disorders. The questionnaire items used in the POSEIDON study such as anaemia, loss of appetite, headache, body ache, and psychological problems could have been symptoms of depressive disorders. Similarly, chest pain or tightness, breathlessness, and dizziness or giddiness could have been symptoms of anxiety disorders. Headache, body ache, diarrhoea or constipation, abdominal pain, sprains, muscle aches, arthritic pain, and joint swellings could have been symptoms of somatoform disorders. The second reason for the absence of common mental disorders reported in this study is that the participants' doctors (family doctors, paediatricians, or general physicians) might not have been adequately trained and equipped to detect and manage common mental disorders in primary health care. Patients with common mental disorders in primary health care often receive symptomatic treatment ranging from analgesics, multivitamins, and intravenous infusion with either Ringer's lactate solution, normal saline, or 5% dextrose.5Isaacs AN Srinivasan K Neerakkal I Jayaram G Initiating a community mental health programme in rural Karnataka.Indian J Community Med. 2006; 31: 86-87Google Scholar This inappropriate care could reflect the inadequate attention to psychiatry training in undergraduate medical education in India and mismatching of the skills of family doctors, who then underdiagnose and undertreat common mental disorders in their already busy practices. In view of the major limitation of the study discussed above, we believe that the results of this study cannot be generalised to the primary health-care setting in India. Common mental disorders can be identified as easily as other illnesses identified in the study, if health-care practitioners are adequately trained. We hope that the authors of the POSEIDON study will include this important group of disorders in their future investigations. We declare no competing interests.