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What constructs do GPs use when diagnosing psychological problems?

David Armstrong1, Geoff Earnshaw

  • 1Department of General Practice, Guy's, King's and St Thomas' School of Medicine, Kings College London. david.amrstrong@kcl.ac.uk

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|August 7, 2004
PubMed
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General practitioners (GPs) identified fewer psychological symptoms than psychiatrists, focusing on anxiety and depression. This highlights a gap in primary care

Area of Science:

  • Psychiatry
  • General Practice
  • Health Psychology

Background:

  • A frequent mismatch exists between general practice and psychiatric diagnoses of psychological issues.
  • General practitioners (GPs) may overlook certain psychological symptoms during consultations.

Purpose of the Study:

  • To determine which items from the 28-item General Health Questionnaire (GHQ-28) best predict GPs' assessments of patient morbidity.
  • To identify GHQ-28 items that predict the proportion of consultation time GPs spend on psychological problems.

Main Methods:

  • A cross-sectional survey was conducted in general practice settings in southeast London.
  • Data from 805 consultations involving 47 GPs were analyzed using stepwise multiple regression.
  • Patients completed the GHQ-28, while GPs independently assessed psychological disturbance and consultation time allocation.

Related Experiment Videos

Main Results:

  • GPs' assessments of psychological disturbance were best predicted by seven GHQ-28 items.
  • GPs' perceptions of time spent on psychological issues were predicted by four GHQ-28 items.
  • Predictive items were mainly from the 'anxiety and insomnia' and 'severe depression' sub-scales, excluding 'somatic' and 'social dysfunction' dimensions.

Conclusions:

  • GPs' diagnostic approach to psychological disturbance overlooks key symptom areas considered important by psychiatrists.
  • There is a significant discrepancy between how GPs and psychiatrists evaluate psychological symptoms in primary care.