The identification of psychiatric illness by primary care physicians: the effect of patient gender.
ABSTRACT This study tested several hypotheses about why women are more likely than men to have psychiatric disorders noted by their primary care physicians.
Patients were screened for mental disorders using the General Health Questionnaire. A stratified sample was assessed using the Schedule for Affective Disorders and Schizophrenia. Information on utilization and identification of mental health problems was abstracted from the medical records.
The study was conducted at a multispecialty group practice in a semirural area of Wisconsin.
Study participants consisted of a stratified probability sample of 247 patients seeking primary care.
Patients with a psychiatric illness who were relatively frequent users of the clinic were most likely to be identified by a physician as having a mental health problem. When psychiatric illness and utilization rates were statistically controlled, men and women had comparable identification rates.
- SourceAvailable from: Georg H. Eifert
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ABSTRACT: Depression is a major public health problem. The distress and functional and social disability it causes are costly to individuals and families, the health care system, and society. The majority of depressed patients are treated by primary care clinicians. Understanding is limited about the factors that affect the pathway to outpatient care for depression in HMO settings. This study describes, among members of a large U.S. health maintenance organization (HMO), the predictors of outcomes that represent progress on the pathway to care for depression, focusing in particular on the relative contribution of depressive symptom levels, gender, age, and other medical and nonmedical factors. The study population is an age/sex stratified sample of HMO members aged 25+ (N=7,844). Data sources include member survey questionnaires, medical charts, and automated utilization databases. Data were collected during a baseline year prior to the members' survey response date (1990–1992) and a follow-up year after that date. The study outcomes measured during the followup year were; study subjects' use of primary medical care; chart notations by a primary care clinician of depression diagnoses, antidepressant prescriptions, and referrals to specialty mental health care; and use of specialty mental health care. Predictor variables included age, gender, level of depressive symptoms, social role functioning, mental health care history, general health status, baseline health care utilization, sociodemographic characteristics, and relation to a personal primary care clinician (and the specialty of that clinician).Research in community and mental health 01/2000; 11:29-63.
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ABSTRACT: Objective:To compare the diagnostic accuracies of internal medicine and family medicine residents in identifying psychosocial distress in ambulatory patients. Design:410 consecutive patients in two hospital-based residency clinics were enrolled. Psychosocial distress was assessed using the General Health Questionnaire (GHQ). Residents, blinded to the goals of the study and the results of the GHQ, documented clinically identified psychosocial distress. Main results:Overall concordance between the residents and the GHQ in identifying the presence or absence of psychosocial distress was 60%. There was no difference in the diagnostic performances of the two resident groups. Sensitivity for the identification of psychosocial distress when the resident groups were combined was 32.3%. Conclusions:The concordance between a commonly used, well-validated screening test for psychosocial distress and resident diagnosis was 60%. This may reflect the need for more effective training of residents in this area of diagnosis or the need for better screening methods.Journal of General Internal Medicine 11/1991; 6(6):529-534. · 3.42 Impact Factor