Why patients of low socioeconomic status with mental health problems have shorter consultations with general...

Poor people receive shorter consultations in general practice than more affluent people. Our aim was to study the two reasons generally advanced for this for patients consulting with mental health problems: people of low socioeconomic status (SES) demand shorter consultations or they tend to match with practitioners who devote little time to their patients.

Of 600 general practitioners (GPs), 144 agreed to participate. During the study period (2005), 713 patients consulted with mental health problems of whom 405 (56.8%) completed questionnaires. Of these, 144 (34.8%) were defined as suffering from Major Depressive Disorder (MDD). Multilevel modelling was used to explore the relationship between patient and GP characteristics, and duration of the consultation.

A multivariate model found two significant patient variables for the consultation duration: severity of MDD symptoms (P = 0.01) and SES (proxied by education level, P = 0.05). The multilevel model including GPs' characteristics demonstrated that the apparent correlation between patients' SES and consultation length was due to a confounding factor: low SES patients were visiting GPs who are, generally, providing shorter consultations (P < 0.001). With the SES variable no longer significant: P = 0.2, although severity of symptoms remained in the model (P = 0.001).

The shortness of the consultation length is due to a supply-side effect, implicating dissatisfaction for patients with mental health problems. This may not be generalizable to other patients. Findings are in favour of a specific intervention aimed at giving poor people equal access to GPs' time.