title: GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms.
abstract: BACKGROUND
  Frequent attendance in general practice increases workload and affects doctor-patient relationships. It is a complex phenomenon, but patients' psychological problems appear to be important.
  
  
  OBJECTIVE
  To assess whether frequent attendance is more likely to be associated with depressive symptoms than with physical health problems.
  
  
  METHODS
  The study was carried out in two general practices: one in Liverpool and one in Granada. Subjects comprised 127 frequent attenders (FAs) plus 175 matched controls, stratified by age and sex. Measures included demographic factors, Beck Depression Inventory (BDI), self-reported health, and current health problems classified by ICHPPC-2 criteria.
  
  
  RESULTS
  Seventy-five (59%) FAs had a BDI score > or = 13, compared with 9 (5%) controls (odds ratio [OR] = 26.6, 95% confidence interval [CI] = 12.4 to 56.8, P < 0.001). A total of 136 (78%) controls reported their health to be good or excellent, compared with 40 (31%) FAs (OR = 7.6, 95% CI = 4.5 to 12.7, P < 0.001). Respiratory problems were present in 50 (39%) FAs and 47 (27%) controls (chi 2 = 6.992, P < 0.03). Depression rates were similar in Liverpool and Granada, although Liverpool subjects were less likely to report good health. On logistic regression, BDI status was the major predictor of frequent attendance (OR = 17.18, 95% CI = 7.54 to 39.01). Self-reported ill health (OR = 2.67, 95% CI = 1.40 to 5.10) and respiratory problems (OR = 2.20, 95% CI = 1.11 to 4.37) were also associated with frequent attendance.
  
  
  CONCLUSIONS
  Depressive symptoms were the major predictor of frequent attendance in this study. Clinical and research activity should therefore concentrate on the identification and management of psychological problems among FAs in general practice.
authors.affiliation: Department of Primary Care, University of Liverpool, UK.
authors.forename: C F
authors.initials: CF
authors.lastname: Dowrick
authors.forename: J A
authors.initials: JA
authors.lastname: Bellón
authors.forename: M J
authors.initials: MJ
authors.lastname: Gómez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012737:Sex Factors; D012923:Social Class; D013030:Spain / Q000453:epidemiology; D016526:Workload