Psychiatric illness in general practice. A detailed study using a new method of case identification

Area of Science:

• Psychiatry
• General Practice
• Epidemiology

Background:

• Psychiatric morbidity in primary care is significant.
• A substantial portion of psychiatric illness remains undiagnosed or
• hidden
• in general practice settings.

Purpose of the Study:

• To evaluate the effectiveness of the General Health Questionnaire (GHQ) in detecting psychiatric disturbance in a general practice setting.
• To assess the prevalence of both conspicuous and hidden psychiatric morbidity.
• To examine the course and characteristics of psychiatric illness in primary care patients.

Main Methods:

• Administered the General Health Questionnaire to 553 general practitioner attendees.
• Conducted standardized psychiatric interviews with 200 patients for validation.
• Assessed psychiatric morbidity and followed up with patients after six months.

Main Results:

• The GHQ correctly classified over 90% of patients as "well" or "ill" with a strong correlation (+0.80) to clinical assessment.
• Conspicuous psychiatric morbidity was 20%, with hidden morbidity accounting for one-third of disturbed patients.
• Two-thirds of initially identified psychiatric cases functioned normally at six-month follow-up.

Conclusions:

• The General Health Questionnaire is a valid tool for screening psychiatric disturbance in primary care.
• Hidden psychiatric morbidity, often presenting with physical symptoms, is common and shares similar outcomes to conspicuous cases.
• Minor affective illnesses and physical complaints frequently co-occur and generally have a favorable prognosis.