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• W102180568 abstract "Editor—Kessler et al found that doctors detected psychiatric illness in less than half of patients scoring highly on the general health questionnaire (85% of patients with a normalising attributional style and 38% with a psychologising style were not detected).1 These data are in accordance with the work that we did in four Spanish primary care centres. Using the general health questionnaire-28 in the first part of the study and a SCAN interview2,3 in the second, we found similar figures of non-recognition of psychiatric illness4 and the same relevance of somatisation to lower rates of recognition of mental illness by general practitioners.5In her commentary on the paper Heath doubts that scoring highly on the general health questionnaire could be equated with having a treatable disorder. We agree with her that the general health questionnaire is a screening questionnaire, not a diagnostic tool, and that doctors should not talk of depression and anxiety just because patients scored highly on the questionnaire. But Kessler et al’s findings are relevant. Questionnaires such as the general health questionnaire provide an approximation of the rate of well defined psychiatric illness in primary care. The diagnosis and treatment of psychiatric illness by general practitioners are usually based on a suspicion about mental illness rather than on diagnostic criteria according to current nosology.In an attempt to analyse this issue we repeated the analysis of our data only for those with a definite affective or anxiety disorder. In our published study we collected data on patterns of symptom presentation (“attributional style”—physical, psychologising, and mixed symptoms). Among the (unweighted) 72 patients with these diagnoses as defined in the international classification of diseases, 10th revision (18 depression, 12 dysthymia, 2 cyclothymia, 3 panic disorder, 31 generalised anxiety disorder, 2 obsessive-compulsive disorder, 4 phobic anxiety), only 11 (23%) of the 47 with somatising attributions were recognised by their general practitioner as having affective or anxiety disorder. Equivalent figures were 93% (14/15) of the psychologising attributions group and 90% (9/10) of the “mixed” group.We also performed a logistic regression, with recognition of psychiatric caseness by the general practitioner as a dependent variable; symptom attribution and marital status were included as significant variables influencing recognition by the general practitioner. Patients with psychologising and mixed style attributions were more likely to be detected by general practitioners (table), as were married and previously married patients. Thus our results support the relevance of attributional style in patients with well defined depressive and anxiety disorders, for whom effective treatments exist." @default.
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• W102180568 modified "2023-10-16" @default.
• W102180568 title "Recognition of depression and anxiety in primary care" @default.
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• W102180568 doi "https://doi.org/10.1136/bmj.318.7197.1558" @default.
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