The treatment of common mental health problems in general practice

Abstract

Background. Previous studies report GPs under-treat mental health disorders, particularly depression, and treatments are non-specific and lack an evidence base. They conclude further training and education of GP's is required. Objective. To describe the treatment of common mental health disorders in relation to the level and severity of psychological problems as defined by the GP and external assessment. Methods. Cross sectional survey of General Practice attenders in New Zealand. Fifty consecutive adult patients were recruited from each practice of 70 randomly selected GP's. The psychological status of 773 respondents selected via the General Health Questionmaire (GHQ) was assessed, and details of management provided. Management options were compared with the level of psychological problem identified by the GP. Results. Treatment varied depending on the level of problem identification, and frequency of consultation, from 93% given treatment when an explicit diagnosis was made to 22.3% in patients with subclinical symptoms. The most commonly given treatment with an explicit diagnosis was psychotropic medication [73% (95% CI 63.6–82.9)] while for those patients with subclinical symptoms the most common form of treatment was discussion and counselling [15.7% (7.1–24.2)]. Only 1.7% (0.3–3.0) of patients with subclinical symptoms received psychotropics. Conclusion. There is a clear association between the level of psychological problem identified and treatment. In contrast to previous views that treatment often appears to be given regardless of diagnosis, these results provide a picture of general practice management of common mental disorders more in line with evidence-based practice than previously described.