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[The diagnosis of mental disorders by the primary care physician]
L Chocrón Bentata1, J Vilalta Franch, I Legazpi Rodríguez
1Centro de Salud Maluquer Salvador, Girona.
Objectives:
To determine the percentage of psychiatric disorders recognised by primary care doctors and what influence the reason for consultation exerts on the psychiatric diagnosis.
Design:
A crossover study of the prevalence of psychopathology. A two-phase study was performed, with systematic sampling of one in every four visits. The GHQ-28 was used in the first phase and Goldberg's CIS in the second; a diagnosis was assigned in line with the criteria of the DSM-III-R. This diagnosis was compared with the general practitioner's, if this existed.
Setting:
"Maluquer Salvador" Health Centre in Girona.
Patients:
A sample of 400 patients between 15 and 65 who attended the centre. 2.9% were lost (2.1% in the first phase and 0.8% in the second).
Measurements And Main Results:
The GP diagnosed 36.7% of the psychiatric disorders of those attending his/her clinics, mainly because only half the patients "suggested" their problem. In 21.2% of the cases when patients "suggested" their psychopathology, they left the consultation without a diagnosis. This was particularly serious in the case of major depression.
Conclusions:
Given the high prevalence of psychopathology, the low diagnostic percentages of the general practitioner's and the difficulty the patient has in suggesting his/her problem, primary care clinics clearly require improvement in case-finding and the use of the GHQ-28 as an instrument in case-finding.