Disability and the detection of mental disorder in primary care

Despite the importance of disability associated with common mental disorders, research on the detection of mental disorders in primary care has scarcely explored its relevance. Aims To describe the disability burden of primary care patients with common mental disorders and subthreshold disorders and to examine the association between general practitioner's (GP) recognition of mental disorder and disability. Design Cross-sectional survey of GPs and their patients. Setting General practices in the lower North Island of New Zealand. Method Participants were randomly selected: GPs (n=70) and their patients (n=3414, of whom a subset of 775 from the basis of this paper). Formal DSM-IV diagnoses were made with the Composite International Diagnostic Interview (CIDI), and psychosomatic and psychological symptoms were measured with the Somatic and Psychological Health Report. Disability was measured with the World Health Organisation's Disability Assessment Schedule-version II. GPs independently rated the severity of psychological symptoms and the presence or absence of disorder. Results The principal findings were (1) that disability was associated with both mental disorder and subthreshold disorder with no significant difference in the level of disability between these categories, and (2) that GPs were less sensitive to the presence of mental disorders as defined by the CIDI if there was little concomitant disability, and in subthreshold cases, the presence of disability increased the chance of GPs identifying clinically significant symptoms. Conclusion Studies of GP recognition of mental disorder have almost exclusively adopted the perspective of concepts of disorder as defined by psychiatry. This study provides some insight into the way GPs attend to both symptoms and functioning in their assessments of psychological syndromes. Disability is an important cue to recognition of mental health problems in the primary care setting, including those that are not recognised by standardised psychiatric assessment but which may still be relevant to patient suffering.