title: General practitioners miss disability and anxiety as well as depression in their patients with osteoarthritis.
abstract: BACKGROUND
  General practitioners (GPs) integrate physical, psychological, and social factors when assessing patients, particularly those with chronic diseases. Recently, the emphasis has been on assessment of depression but not of other factors.
  
  
  OBJECTIVE
  To determine functional disability, psychological morbidity, social situation, and use of health and social services in patients with osteoarthritis and examine GP knowledge of these factors.
  
  
  METHODS
  Two hundred patients completed a validated postal questionnaire about functional disability (Health Assessment Questionnaire [HAQ]), mood (Hospital Anxiety and Depression Scale [HAD]), employment status, who they lived with, welfare benefits received, and use of health and social services. A similar questionnaire was completed by the patient's GP, including a HAQ. However, a three-point scale was used to assess depression and anxiety.
  
  
  RESULTS
  Forty-seven per cent of patients were moderately or severely disabled (HAQ > 1). GPs underestimated functional disability: mean patient HAQ = 1.04 (95% confidence interval [CI] = 0.92-1.16), mean GP HAQ = 0.74 (95% CI = 0.65-0.83), and there was low correlation between patient and GP scores (kappa = 0.24). There was moderate prevalence of depression and high prevalence of anxiety, which the GP often did not recognise: patient depression = 8.3% (95% CI = 4.1%-12.8%), GP depression = 6.0% (95% CI = 2.4%-9.6%), kappa = 0.11; patient anxiety = 24.4% (95% CI = 17.8%-31.0%), GP anxiety = 11.9% (95% CI = 6.9%-16.9%), kappa = 0.19. Only 46% of severely disabled patients (HAQ > 2) were receiving disability welfare benefits. GPs were often unaware of welfare benefits received or the involvement of other professionals.
  
  
  CONCLUSIONS
  GPs frequently lack knowledge about functional disability, social factors, and anxiety as well as depression in their patients with osteoarthritis.
authors.affiliation: Division of Primary Health Care, University of Bristol. david.memel@bris.ac.uk
authors.forename: D S
authors.initials: DS
authors.lastname: Memel
authors.forename: J R
authors.initials: JR
authors.lastname: Kirwan
authors.forename: D J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: M
authors.initials: M
authors.lastname: Hehir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D004185:Disability Evaluation; D005194:Family Practice; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications* / Q000175:diagnosis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome