Cross sectional study of symptom attribution and recognition of depressionand anxiety in primary care

Objectives To examine the effect of patients' causal attributions of common somatic symptoms on recognition by general practitioners of cases of depre ssion and anxiety and to test the hypothesis that normalising attributions make recognition less likely. Design Cross sectional survey. Setting One general practice of eight doctors in Bristol. Subjects 305 general practice attenders. Main outcome measure The rate of detection by general health questionnaire and the symptom interpretation questionnaire, which scores style of symptom attribution along the dimensions of psychologising, somatising, and normal ising. General practitioners detected depression or anxiety in 56 (36%; 95% confidence interval 28% to 44%) of the 157 patients who scored highly on t he general health questionnaire. Subjects with a normalising attributional style were less likely to be detected as cases; doctors did not make any ps ychological diagnosis in 46 (85%; 73% to 93%) of 54 patients who had high q uestionnaire and high normalising scores. Those with a psychologising style were more likely to be detected; doctors did not detect 21 (38%; 25% to 52 %) of 55 patients who had high questionnaire and high psychologising scores . The somatisation scale was not associated with low detection rates. This pattern of results persisted after adjustment for age, sex, general health questionnaire score, and general practitioner. Conclusions Normalising attributions minimise symptoms and are non-patholog ical in character. The normalising attributional style is predominant in ge neral practice attenders and is an important cause of low rates of detectio n of depression and anxiety.