Occurrence, recognition, and outcome of psychological disorders in primary care

OBJECTIVE: The authors' goal was to cross-validate the earlier finding of the Groningen Primary Care Study that recognition of psychological disorders was associated with better patient outcomes. METHOD: The 12- item General Health Questionnaire was used to screen 1,271 consecutive primary care patients. A stratified sample of 340 of these patients participated in the second-stage baseline series of interviews, which included the Composite International Diagnostic Interview, the occupational role section of the Social Disability Schedule, the 28- item General Health Questionnaire, and the SCL-90. Three months later 209 of the patients completed the 28-item General Health Questionnaire and the SCL-90, and 12 months later 213 of the patients completed the second-stage baseline series of interviews. The study was carried out in six primary care practices (11 general practitioners) in the northern part of The Netherlands. RESULTS: Recognition of psychological disorders was associated with higher initial severity of psychopathology and occupational disability and with a psychological reason for the medical encounter. Recognition rates were higher for anxiety than for depression. Patients whose psychological disorders were recognized did not have better outcomes than those whose psychological disorders were not recognized. CONCLUSIONS: Recognition of psychological disorders was not associated with better outcome. Recognition is a necessary but not a sufficient condition for delivery of treatment according to clinical guidelines. Increasing recognition is likely to improve outcomes only if general practitioners have the skills and resources to deliver adequate interventions.