Psychosocial problem disclosure by primary care patients

Area of Science:

• Primary Care Medicine
• Psychiatry
• Health Services Research

Background:

• Many psychologically distressed patients in primary care initially present only with physical symptoms.
• The frequency of psychosocial problem disclosure and its predictors in these patients remain unclear.

Purpose of the Study:

• To determine the frequency of psychosocial problem disclosure by distressed primary care patients.
• To examine the impact of prior physician inquiry and patient variables on disclosure.
• To assess how disclosure affects primary care physicians' recognition of mental health issues.

Main Methods:

• A study involving 308 adult patients with significant psychological distress (GHQ-28 score ≥ 5) across 69 primary care practices.
• Data collected on psychosocial problem disclosure, prior psychosocial inquiry by physicians, physician-patient familiarity, and patient distress severity.
• Statistical analysis to identify predictors of disclosure and the effect of disclosure on mental health problem recognition.

Main Results:

• Psychosocial problems were disclosed in 51% of patient visits overall, increasing to 67% when physicians inquired beforehand.
• Disclosure was significantly predicted by prior inquiry (p < 0.001), physician-patient familiarity (p < 0.001), and patient distress severity (p < 0.001).
• Disclosure was associated with a 24-fold increase in the odds of mental health problem recognition by primary care physicians.

Conclusions:

• Primary care physicians can elicit psychosocial disclosures from most distressed, somatically presenting patients through inquiry.
• Asking brief questions about mood or interpersonal issues can substantially improve psychosocial disclosure rates.
• Physician inquiry is a simple yet effective strategy to uncover hidden mental health concerns in primary care settings.