Deciding who gets treatment for depression and anxiety: a study of consecutive GP attenders.
BACKGROUND
Most research has focused on recognition by GPs of the common mental disorders: depression and anxiety. However, less is known about the factors that determine whether patients with those disorders that are recognised receive any active treatment.


OBJECTIVE
To investigate factors associated with receiving active treatment among consecutive attenders identified by GPs as having a common mental disorder.


METHODS
Data were collected as part of a cluster randomised controlled trial in 30 general practices in the south of Bristol, UK, on the impact of mental health guidelines in primary care.


METHODS
We studied 439 consecutive general practice attenders aged 16-64 years who were given a diagnosis of depression, anxiety, or chronic mixed anxiety and depression by their GP. The main outcome measure was the provision of any active treatment, whether pharmacological or psychological, for these disorders. Patient, GP, and practice level data, including sociodemographic, clinical, and administrative data were explored as predictors in a logistic regression model. Huber White variance estimates were used to account for hierarchical clustering.


RESULTS
Of those patients identified as having a common mental disorder by the GP, 54% were offered active treatment. Higher symptom score, as measured by the General Health Questionnaire (GHQ) (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.06 to 1.13; P<0.001) and being male (OR = 1.54; 95% CI = 1.13 to 2.09; P = 0.006), were both associated with an increased likelihood of being offered active treatment. Patients with anxiety (OR = 0.24; 95% = CI 0.14 to 0.41; P<0.001), or chronic mixed anxiety/depression (OR = 0.41; 95% CI = 0.23 to 0.73; P = 0.003) were less likely to be offered active treatment than those considered to have depression.


CONCLUSIONS
When deciding to offer active treatment for common mental disorders, GPs appear to be influenced by the severity of symptoms rather than their 'understandability' in relation to recent life stresses or the social context of distress. Further research is needed to investigate why men are more likely and those with an anxiety disorder less likely, to be offered active treatment.
Hyde
Julia
J
King's College London Institute of Psychiatry, Health Psychology Section, Kings College London.
Evans
Jonathan
J
Sharp
Debbie
D
Croudace
Tim
T
Harrison
Glynn
G
Lewis
Glyn
G
Araya
Ricardo
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy*; D001291:Attitude of Health Personnel; D003657:Decision Making; D003866:Depressive Disorder / Q000628:therapy*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012720:Severity of Illness Index