GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms

Background. Frequent attendance in general practice increases workload and affects doctor-patient relationships. It is a complex phenomenon, but patie nts' psychological problems appear to be important Aim. To assess whether frequent attendance is more likely to be associated with depressive symptoms than with physical health problems. Method. The study was carried out in two general practices: one in Liverpoo l and one in Granada. Subjects comprised 127 frequent attenders (FAs) plus 175 matched controls, stratified by age and sex. Measures included demograp hic factors, Beck Depression Inventory (BDI), self-reported health, and cur rent health problems classified by ICHPPC-2 criteria. Results. Seventy-five (59%) FAs had a BDI score greater than or equal to 13 , compared with 9 (5%) controls (odds ratio [OR] = 26.6 95% confidence inte rval [CI] = 12.4 to 56.8 P < 0.001). A total of 136 (78%) controls reported their health to be good or excellent, compared with 40 (31%) FAs (OR = 7.6 , 95% CI = 4.5 to 12.7, P < 0.001). Respiratory problems were present in 50 (39%) FAs and 47 (27%) controls (chi(2) = 6.992, P < 0.03). Depression rat es were similar in Liverpool and Granada, although Liverpool subjects were less likely to report good health. On logistic regression, BDI status was t he major predictor of frequent attendance (OR = 17.18, 95% CI = 7.54 to 39. 01). Self-reported ill health (OR = 2.67, 95% CI = 1.40 to 5.10) and respir atory problems (OR = 2.20, 95% CI = 1.11 to 4.37) were also associated with frequent attendance. Conclusion. Depressive symptoms were the major predictor of frequent attend ance in this study. Clinical and research activity should therefore concent rate on the identification and management of psychological problems among F As in general practice.