Health care utilization in primary care: Meaning of psychiatric disorders and adverse childhood experiences

There is evidence that the use of the health care system with respect to somatic treatment and diagnoses is strongly influenced by the psychological determinants of the patients. The aim of this study is to analyze the effect of psychic comorbidities and childhood adversities on the usage of the primary health care system. A total of 453 patients were examined in the practices of their general practitioners with regard to childhood adversities. Data of 366 patients could be combined with the records of the practitioners about health care utilisation, and somatic and psychiatric diagnoses. A graphical Markov model was used to analyse the interdependencies, Psychiatric disorders influence the number of doctor visits and the time the practitioner spends with the patient. The latter was found to be the case, not only with regard to psychiatric but also to somatic treatment and diagnostic procedures aiming to discover somatic disease. There is no evidence that conversely somatic disorders increase psychiatric oriented diagnosis. Childhood adversities are not associated with any parameter of health care use that was examined. To optimize diagnostic and therapy of psychiatric and somatic dysfunctions and to avoid detentions, the strict separation of somatic medicine (first) and (then) psychiatric diagnostics and treatment should become Subject to discussion.