Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire

Area of Science:

• Psychiatry
• Primary Care Medicine
• Epidemiology

Background:

• Detecting psychiatric disorders in primary care is challenging.
• General practitioners (GPs) play a crucial role in initial patient assessment.
• Accurate identification of mental health conditions is vital for timely intervention.

Purpose of the Study:

• To compare the diagnostic capabilities of GPs with a pen-and-paper screening tool.
• To evaluate the effectiveness of the General Health Questionnaire (GHQ) in identifying psychiatric cases in primary care.
• To assess the sensitivity and specificity of both methods.

Main Methods:

• A psychiatrist interviewed a stratified sample of 283 patients from 590 new illnesses across 15 general practices.
• Two research diagnostic systems were used to establish 'caseness'.
• The performance of GPs and the GHQ was compared against these research diagnoses, using DSM-3 criteria.

Main Results:

• Psychiatric diagnoses were established in approximately 30% of new illnesses.
• The GHQ demonstrated a sensitivity of 87.1% and specificity of 75.4% using DSM-3 criteria.
• GPs had lower false positive rates but were significantly more likely to miss psychiatric cases (sensitivity around 50%).

Conclusions:

• The General Health Questionnaire substantially enhances the detection of psychiatric disorders in primary care settings.
• Integrating screening tools like the GHQ can significantly improve the sensitivity of psychiatric case identification by GPs.
• While GPs are effective at reducing false positives, the GHQ is crucial for improving the overall detection rate of mental health conditions.