General practice consultation rates for psychiatric disorders in patients aged 65 and over: prospective cohort study

To examine consultation rates for psychiatric disorder in general practice among patients aged 65 years and over; and to examine the effect of sociodemographic factors (gender, age, social class and accommodation) on consultation rates.

Prospective cohort study. The fourth national survey of morbidity in general practice carried out between September 1991 and August 1992. Sixty volunteer practices in England and Wales took part; study population comprised a 1% sample of the population (502,493 patients). GPs recorded the reasons for all consultations and these were converted into an ICD9 code. Trained fieldworkers collected sociodemographic data on the patients in the survey.

Psychiatric disorders were categorised by compiling the appropriate ICD9 codes. Annual consultation rates (per 1000 patients) according to psychiatric disorder and sociodemographic factors were calculated after adjustment for differing length of follow-up.

Only 4.4% of all consultations were for psychiatric disorders. Women had consultation rates 75% higher than men. Social class had no effects on rates. Consultation rates were highest for neurotic disorders and depression. Those living alone had highest rates for depression, whilst those living in residential and nursing homes had substantially higher consultation rates for dementia and bipolar affective disorder.

Consultation rates were significantly lower than expected from previous epidemiological studies. This indicates that there is considerable hidden morbidity that is being untreated in primary care. Social class appears to have no effect on consultations for psychiatric disorder in the elderly. The increasing age of the population may result in a significant increase in consultations for dementia, but not for depression or neurosis.