What constructs do GPs use when diagnosing psychological problems?
BACKGROUND
The mismatch between general practice and psychiatric diagnosis of psychological problems has been frequently reported.


OBJECTIVE
To identify which items from the 28-item general health questionnaire (GHQ-28) best predicted general practitioners' (GPs') own assessments of morbidity and the proportion of time spent in consultations on psychological problems.


METHODS
Cross-sectional survey.


METHODS
General practice in southeast London.


METHODS
Eight hundred and five consultations were carried out by 47 GPs, during which patients completed the 28-item GHQ, and doctors independently assessed the degree of psychological disturbance and the proportion of the consultation spent on psychological problems. Data from the consultations were entered into a stepwise multiple regression to determine the best GHQ-item predictors of GP judgements.


RESULTS
GPs' assessments of the degree of psychological disturbance were best predicted using only seven GHQ items, and their perceptions of the proportion of time spent on psychological problems were predicted by only four items. Items were drawn predominantly from the 'anxiety and insomnia' and 'severe depression' sub-scales, ignoring the 'somatic' and 'social dysfunction' dimensions.


CONCLUSIONS
In diagnosing psychological disturbance GPs ignore major symptom areas that psychiatrists judge important.
Department of General Practice, Guy's, King's and St Thomas' School of Medicine, Kings College London. david.amrstrong@kcl.ac.uk
David
D
Armstrong
Geoff
G
Earnshaw
D000293:Adolescent; D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires