Psychiatric morbidity in an Italian general practice

Area of Science:

• Psychiatry
• General Practice
• Epidemiology

Background:

• General practitioners (GPs) often face challenges in accurately identifying psychiatric disorders in primary care settings.
• The effectiveness of two-stage screening strategies, combining GP assessment with specialist interviews or questionnaires, requires further investigation.
• Understanding factors influencing GP diagnostic behavior is crucial for improving mental healthcare delivery.

Purpose of the Study:

• To evaluate the impact of a psychiatrist's presence on a GP's diagnostic behavior within a two-stage psychiatric screening strategy.
• To assess the utility of the General Health Questionnaire (GHQ) as a case-finding instrument in general practice.
• To determine the prevalence of hidden psychiatric morbidity in a primary care setting.

Main Methods:

• A two-stage screening strategy was implemented in a single-handed general practice.
• Group A patients received second-stage psychiatric interviews concurrently with GP assessments and GHQ.
• Group B patients received only GP assessments and GHQ, without concurrent psychiatric interviews.

Main Results:

• The overall true psychiatric disorder rate (36%) remained consistent across both study phases.
• The GP diagnosed psychiatric disorders in 61% of patients during Phase 1 (with psychiatrist present), revealing only 9% hidden morbidity.
• During Phase 2 (without psychiatrist), the GP diagnosed psychiatric disorders in 37% of patients, uncovering 59% hidden morbidity.

Conclusions:

• The presence of a psychiatrist significantly alters a GP's diagnostic threshold for psychiatric disorders.
• The General Health Questionnaire (GHQ) demonstrates effectiveness as a case-finding tool in general practice settings.
• Two-stage screening strategies can reveal substantial hidden psychiatric morbidity, emphasizing the need for improved diagnostic practices.