Course of psychological symptoms and the initial management strategies in general practice using electronic health records in the Netherlands

Clinical Snapshot

Key Findings

• P Value: Not specified in abstract

• Effect Size: 79.4% resolved within 1 year, 12.8% persisted, 7.8% progressed to psychiatric conditions

• Primary Outcome: Course of psychological symptom diagnoses over 1 year

• Nnt Or Sensitivity: Rate ratio 1.76 for increased GP contacts in episodes progressing to psychiatric conditions

• Confidence Interval: Rate ratio 1.76 (95% CI 1.63-1.91) for GP contacts in progression group

Clinical Application

Highly feasible - uses routine primary care data and standard diagnostic practices Directly relevant to Australian general practice; findings support RACGP guidelines on mental health assessment and the stepped care model under Medicare Primary care patients presenting with psychological symptoms (anxiety, depression) in developed healthcare systems

Abstract

BACKGROUND: Patients who consult their GP about psychological complaints, such as feeling anxious or depressed, are often initially given a psychological symptom diagnosis. However, it remains unclear whether these symptoms will develop into psychiatric conditions, which is crucial for informing patients about their prognosis and guiding GPs in their management. AIMS: To explore the course of psychological symptom diagnoses and compare GPs' management strategies for (a) psychological symptom diagnoses that persisted for more than a year and (b) those that changed into psychiatric conditions during the first year of care. METHODS: We performed a retrospective cohort study using the Family-Medicine Network database. We included all episodes of care (EoC) that started with a psychological symptom diagnosis between 2008 and 2021. We performed negative binomial analyses and logistic regression analyses to compare management strategies and number of contacts between EoC that changed into psychiatric conditions and persistent psychological symptoms (>1 year) during the first year of care. RESULTS: Out of the 14 633 EoC that started with a psychological symptom diagnosis, 79.4% resolved within 1 year, 12.8% persisted as psychological symptoms and 7.8% changed into psychiatric conditions. In EoC that changed into psychiatric conditions, as compared with EoC that persisted as psychological symptoms, we observed a significantly higher number of contacts with the GP (RR=1.76, 95% CI 1.63 to 1.91) as well as an increased total number of interventions (RR=1.71, 95% CI 1.58 to 1.84). CONCLUSION: Most psychological symptoms remain for only a short period of time and only a few persist or change into psychiatric conditions. Future research should investigate the factors that influence patients' decisions to seek further help from their GPs as well as those that contribute to the transition from psychological symptom diagnoses to a psychiatric condition.

References

1. 1.Chaabouni, A., Schouten, B., Houwen, J., Lucassen, P., Akkermans, R., Walraven, I., van Boven, K., Schers, H., & Olde Hartman, T. (2026). Course of psychological symptoms and the initial management strategies in general practice using electronic health records in the Netherlands. BMJ Open. https://doi.org/10.1136/bmjopen-2025-108541