COMMUNICATION IN GENERAL-PRACTICE - RECOGNITION AND TREATMENT OF MENTAL-ILLNESS

From previous studies there is a lot of evidence that in primary care settings, many patients tend to express their mental problems in terms of physical symptoms. Therefore, the general practitioner (GP) needs to recognize mental problems at an early stage. Early recognition allo ws for adequate treatment that might speed up recovery. The present ar ticle reports on a study exploring the GP's ability to recognize menta l illness, the communication style that is supposed to support this ab ility, the subsequent treatment of mental problems, and the patient's recovery. Two databases were used. First, an observation study, involv ing 351 videotaped consultations held by 15 GPs, yielded information o n communication style and recognition abilities. Patients in this stud y were selected randomly. The second database obtained treatment data and measures of patient recovery from a 1-year follow-up study dealing with the treatment and course of mental illness. Patients in this stu dy were selected because their GPs considered their problems ''mainly psychosocial by nature''. Half of them were categorized within psychol ogical and social diagnostic categories of the International Classific ation for Primary Care (ICPC), the other half were categorized within physical disease categories, with an assessment by the GP that the com plaints were mainly psychosocial. Results showed no significant relati onships between the recognition of mental illness and nine communicati on features supposed to induce these abilities. There was a tendency h owever, for a positive association between recommended communicative b ehaviour of the GP and his or her tendency to give frequently psychoso cial evaluations of the patient's complaints. Also, there was a negati ve tendency between this recommended behaviour and the degree of agree ment between the GP's evaluation and the score on a psychiatric screen ing questionnaire. This agreement is called ''accuracy''. Frequent psy chosocial evaluations were related to exploring behaviour and mental h ealth referral in case of psychosocial complaints. Further, relationsh ips between the GPs' recognition ability and various measures of patie nts' recovery did not prove univocal. Both positive, negative and abse nt relationships were found. (C) 1998 Elsevier Science Ireland Ltd.