Dysfunctional attitudes and the common mental disorders in primary care

Background: Dysfunctional attitudes may predispose to episodes of depression, although the evidence for this is poor. Most previous studies have been cross-sectional, or have followed up clinical samples. The aim of the study was to test the hypothesis that dysfunctional attitudes are associated with the onset and repeat prevalence of episodes of the common mental disorders among primary care attenders. Methods: A 12-month prospective cohort study of 305 consecutive primary care attenders at a health centre in south London. Results: Linear associations were found between (high) score on the Dysfunctional Attitude Scale (DAS) and both the onset and repeat prevalence of episodes of the common mental disorders over 12 months (unadjusted OR for episode onset 1.05, 95% CI 1.01–1.09) (P=0.009). The association with episode onset, but not with repeat prevalence, remained statistically significant after adjusting for CIS-R score at baseline (OR 1.05, 95% CI 1.00–1.09) (P=0.03). Limitations: This study was based in a single general practice, and had limited power to detect statistically significant interactions between DAS score and socio-economic adversity. Conclusions: Dysfunctional attitudes may be a risk factor for the onset (but not the outcome) of episodes of moderately severe, typically comorbid, anxiety and depression found in primary care settings.