A classification of psychological distress for use in primary care settings

This paper contrasts three ways of conceptualizing emotional distress in general medical settings: high scorers on screening tests, 'cases' according to the doctor seeing them, and standardized research diagnoses. It is shown that distress as measured by screening test is very much more prevalent than research diagnosis, and yet doctors working in general medical settings need to be able to conceptualize disorders using a classification that is helpful for them. The proposed classification is based upon the patient's need for intervention, and it distinguishes the few who need to be thought of as having a formal mental disorder from the many who do not. It takes account of what is known about 'labelling' and compliance, and it is linked to the skills needed by primary care workers. The largest group consists of those whose emotional distress needs recognition and discussion; the next group also needs social interventions; while the final group benefits from recognition of a mental disorder which necessitates a medical or psychological treatment.