title: Deciding who gets treatment for depression and anxiety: a study of consecutive GP attenders.
abstract: 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.
authors.affiliation: King's College London Institute of Psychiatry, Health Psychology Section, Kings College London.
authors.forename: Julia
authors.initials: J
authors.lastname: Hyde
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Debbie
authors.initials: D
authors.lastname: Sharp
authors.forename: Tim
authors.initials: T
authors.lastname: Croudace
authors.forename: Glynn
authors.initials: G
authors.lastname: Harrison
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
mesh_terms: 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