• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Aug 2000; 50(457): 620–625.
PMCID: PMC1313771

Patient determinants of mental health interventions in primary care.


BACKGROUND: A large proportion of a general practitioner's (GP's) caseload comprises patients with mental health problems. It is important to ensure that care is provided appropriately, on the basis of clinical need. It is therefore necessary to investigate the determinants of the use of mental health care in the primary care sector and, in particular, to identify any non-clinical characteristics of patients that affect the likelihood of their receiving appropriate care. AIM: To identify and compare the influence of non-clinical patient factors on GPs' acknowledgement of mental problems and on their provision of mental health care. METHOD: Cross sectional study of adults aged 16 to 65 years old (n = 802) attending one of eight practices (20 GPs in total) in inner west London. RESULTS: Multivariable analysis showed that the combination of factors that best predict GPs' acknowledgement of the presence of mental problems are general health questionnaire (GHQ) scores (odds ratio [OR] = 1.10 per unit increase in score, 95% confidence interval [CI] = 1.07 to 1.13), previous mental symptoms (OR = 7.5, 95% CI = 4.3 to 12.9), increasing age (OR = 1.03 per one-year increase, 95% CI = 1.01 to 1.04) and physical health status (OR = 0.98 per unit increase in short form-36 (SF-36) score, 95% CI = 0.96 to 1.00). Multivariable analysis showed that the combination of factors that best predict intervention (prescription for psychotropic medication; return visit to GP; referral to psychiatric inpatients/outpatients; referral to other [specified] health professionals, or social services) are previous symptoms (OR = 7.4, 95% CI = 3.8 to 14.4), white ethnic group (OR = 2.2, 95% CI 0.9 to 5.5); and not owning a property (OR = 2.1, 95% CI = 1.1 to 4.0). Life events influenced intervention only in the presence of low GHQ scores (OR = 8.1, 95% CI = 2.7 to 24.0). CONCLUSIONS: Mental problems are common in primary care and their acknowledgement is a necessary but not a sufficient condition for intervention. Our results show that GPs' decisions about mental health interventions can be influenced by non-clinical patient factors, regardless of patients' clinical needs. The results suggest that current practice may not always be equitable, and point to the need for better understanding of the basis of these potential inequalities and for focused training.

Full Text

The Full Text of this article is available as a PDF (54K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Ormel J, Van Den Brink W, Koeter MW, Giel R, Van Der Meer K, Van De Willige G, Wilmink FW. Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med. 1990 Nov;20(4):909–923. [PubMed]
  • Catalan J, Gath DH, Bond A, Edmonds G, Martin P, Ennis J. General practice patients on long-term psychotropic drugs. A controlled investigation. Br J Psychiatry. 1988 Mar;152:399–405. [PubMed]
  • Verbrugge LM. How physicians treat mentally distressed men and women. Soc Sci Med. 1984;18(1):1–9. [PubMed]
  • Sashidharan SP, Surtees PG, Kreitman NB, Ingham JG, Miller PM. Affective disorders among women in the general population and among those referred to psychiatrists. Clinical features and demographic correlates. Br J Psychiatry. 1990 Dec;157:828–834. [PubMed]
  • RAWNSLEY K, LOUDON JB. Factors influencing the referral of patients to psychiatrists by general practitioners. Br J Prev Soc Med. 1962 Oct;16:174–182. [PMC free article] [PubMed]
  • MOWBRAY RM, BLAIR W, JUBB LG, CLARKE A. The general practitioner's attitude to psychiatry. Scott Med J. 1961 Jul;6:314–321. [PubMed]
  • Kaeser AC, Cooper B. The psychiatric patient, the general practitioner, and the outpatient clinic: an operational study and a review. Psychol Med. 1971 Aug;1(4):312–325. [PubMed]
  • de Alarcón JG, Sainsbury P, Costain WR. Incidence of referred mental illness in Chichester and Salisbury. Psychol Med. 1975 Feb;5(1):32–54. [PubMed]
  • Brown RM, Strathdee G, Christie-Brown JR, Robinson PH. A comparison of referrals to primary-care and hospital out-patient clinics. Br J Psychiatry. 1988 Aug;153:168–173. [PubMed]
  • Strathdee G, Brown RM, Doig RJ. Psychiatric clinics in primary care. The effect on general practitioner referral patterns. Soc Psychiatry Psychiatr Epidemiol. 1990 Mar;25(2):95–100. [PubMed]
  • Goldberg D, Bridges K, Cook D, Evans B, Grayson D. The influence of social factors on common mental disorders. Destabilisation and restitution. Br J Psychiatry. 1990 May;156:704–713. [PubMed]
  • Paykel ES. Depression in women. Br J Psychiatry Suppl. 1991 May;(10):22–29. [PubMed]
  • Greenley JR. Social factors, mental illness, and psychiatric care: recent advances from a sociological perspective. Hosp Community Psychiatry. 1984 Aug;35(8):813–820. [PubMed]
  • Boardman AP. The General Health Questionnaire and the detection of emotional disorder by General Practitioners. A replicated study. Br J Psychiatry. 1987 Sep;151:373–381. [PubMed]
  • Hoeper EW, Nycz GR, Kessler LG, Burke JD, Jr, Pierce WE. The usefulness of screening for mental illness. Lancet. 1984 Jan 7;1(8367):33–35. [PubMed]
  • Odell SM, Surtees PG, Wainwright NW, Commander MJ, Sashidharan SP. Determinants of general practitioner recognition of psychological problems in a multi-ethnic inner-city health district. Br J Psychiatry. 1997 Dec;171:537–541. [PubMed]
  • Vázquez-Barquero JL, García J, Simón JA, Iglesias C, Montejo J, Herrán A, Dunn G. Mental health in primary care. An epidemiological study of morbidity and use of health resources. Br J Psychiatry. 1997 Jun;170:529–535. [PubMed]
  • Blacker CV, Clare AW. Depressive disorder in primary care. Br J Psychiatry. 1987 Jun;150:737–751. [PubMed]
  • Marks JN, Goldberg DP, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979 May;9(2):337–353. [PubMed]
  • Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed]
  • Goldberg D. Identifying psychiatric illness among general medical patients. Br Med J (Clin Res Ed) 1985 Jul 20;291(6489):161–162. [PMC free article] [PubMed]
  • Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ. 1993 May 29;306(6890):1440–1444. [PMC free article] [PubMed]
  • Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160–164. [PMC free article] [PubMed]
  • KESSEL WI. Psychiatric morbidity in a London general practice. Br J Prev Soc Med. 1960 Jan;14:16–22. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...