title: Unmet need for recognition of common mental disorders in Australian general practice.
abstract: To determine the rate and predictors of unmet need for recognition of common mental disorders in Australian general practice.
  
  
  
  Cross-sectional national audit of general practices throughout Australia in 1998-1999.
  
  
  
  46 515 ambulatory care patients attending 386 GPs.
  
  
  
  Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of recognition of mental disorders by GPs--GPs reporting whether patients had depression, anxiety, mixed depression/anxiety, somatoform, or other psychological disorder; predictors of unmet need for recognition of mental disorders--self-report questions about demography for patients and GPs, and about practice organisation for GPs.
  
  
  
  Reported recognition of psychological disorders by GPs; actual prevalence of disorders; and patient, GP and practice characteristics predicting the failure to recognise disorders.
  
  
  
  GPs did not recognise mental disorder in 56% (11922/21210) of patients. These comprised 46% (5134/11060) of patients in the higher level of mental disorders, and (in the second level of disorders) 58% (2906/5036) of patients with predominantly psychological symptoms, and 76% (3882/5114) of those with predominantly somatic symptoms. Patients more likely to have their need for psychological assessment met had the following characteristics: middle-aged (odds ratio [OR], 1.76; 95% CI, 1.59-1.96), female (OR, 1.19; 95% CI, 1.12-1.27), Australian-born (OR, 1.16; 95% CI, 1.08-1.24), unemployed (OR, 1.75; 95% CI, 1.64-1.89), single (OR, 1.52; 95% CI, 1.41-1.61), presenting with mainly psychological symptoms (OR, 3.54; 95% CI, 3.28-3.81), and presenting for psychological reasons (OR, 4.20; 95% CI, 3.02-5.82). Characteristics of doctors associated with meeting patients' need for assessment were being aged over 35 years (OR, 1.51; 95% CI, 1.09-2.08), having an interest in mental health (OR, 1.27; 95% CI, 1.15-1.41), having had previous mental health training (OR, 1.29; 95% CI, 1.15-1.45), being in part-time practice (OR, 1.23; 95% CI, 1.09-1.39), seeing fewer than 100 patients per week (OR, 1.29; 95% CI, 1.13-1.47), working in practices with fewer than 2000 patients (OR, 1.28; 95% CI, 1.13-1.45) and working in regional centres (OR, 1.16; 95% CI, 1.05-1.28).
  
  
  
  Unmet need for recognition of common mental disorders remains high. Predictors of unmet need include a somatic symptom profile and practitioner and organisational characteristics which impede the provision of high quality mental health services.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney. ian.hickle@beyondblue.org.au
authors.forename: I B
authors.initials: IB
authors.lastname: Hickie
authors.forename: T A
authors.initials: TA
authors.lastname: Davenport
authors.forename: E M
authors.initials: EM
authors.lastname: Scott
authors.forename: D
authors.initials: D
authors.lastname: Hadzi-Pavlovic
authors.forename: S L
authors.initials: SL
authors.lastname: Naismith
authors.forename: A
authors.initials: A
authors.lastname: Koschera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D010348:Patient Care Team; D010555:Personality Inventory; D010819:Physician's Role