Unequal access and unmet need: neurotic disorders and the use of primary care services.
BACKGROUND
In this paper we use data from the National Survey of Psychiatric Morbidity to examine how many people with neurotic disorders receive professional evaluation, and how this is affected by clinical and sociodemographic differences. We hypothesized that psychiatric symptoms and attendant dysfunctions would both have an effect on contacting, and that key demographic variables would not.


METHODS
The household component of the British National Surveys of Psychiatric Morbidity was based on a random sample of > 10,000 subjects. Psychiatric symptoms and ICD-10 diagnosis were established by lay interviewers using the CIS-R. Social dysfunction was tapped by asking about difficulties in performing seven types of everyday activity. We examined symptom score, ADL deficit score and demographic variables in relation to contact with primary care physicians for psychiatric symptoms.


RESULTS
The major determinant of contacting a primary care physician was severity, mainly due to the level of psychiatric symptoms, but with an independent contribution from social dysfunction. There were also significant contributions from sex, marital status, age, employment status and whether the subject had a physical condition as well.


CONCLUSIONS
The major influence on whether people seek the help of their family doctors for mental health problems is the severity of disorder. Although there are some social inequalities in access to family doctors, these are less important. The most salient finding from our study is that even people suffering from high levels of psychiatric symptoms very often do not have contact with professionals who might help them.
Bebbington
P E
PE
Department of Psychiatry and Behavioural Sciences, RF & UCL Medical School, Institute of Psychiatry and Office for National Statistics, London.
Meltzer
H
H
Brugha
T S
TS
Farrell
M
M
Jenkins
R
R
Ceresa
C
C
Lewis
G
G
D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009497:Neurotic Disorders / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012494:Sampling Studies; D012720:Severity of Illness Index; D012917:Social Adjustment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom