Who is at risk of nondetection of mental health problems in primary care?

OBJECTIVE: To determine patient and provider characteristics associated wit h increased risk of nondetection of mental health problems by primary care physicians. DESIGN: Cross-sectional patient and physician surveys conducted as part of the Medical Outcomes Study. PARTICIPANTS: We studied 19,309 patients and 349 internists and family phys icians. MEASUREMENTS AND MAIN RESULTS: We counted "detection" of a mental health pr oblem whenever physicians reported, in a postvisit survey, that they though t the patient had a mental health problem or that they had counseled or ref erred the patient for mental health. Key independent variables included pat ient self-reported demographic characteristics, health-related quality of l ife (HRQOL), depression diagnoses according to the Diagnostic and Statistic al Manual of Mental Disorders, and physician demographics and proclivity to provide counseling for depression. Logistic regression analysis, adjusted for HRQOL, revealed physicians were less likely to detect mental health pro blems in African Americans (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.46 to 0.86), men (OR, 0.64; 95% CI, 0.54 to 0.75), and patients you nger than 35 years (OR, 0.61; 95% CI, 0.44 to 0.84), and more likely to det ect them in patients with diabetes (OR, 1.4; 95% CI, 1.0 to 1.8) or hyperte nsion (OR, 1.3; 95% CI, 1.1 to 1.6). In a model that included DSM-III diagn oses, odds of detection remained reduced for African Americans as well as f or Hispanics (OR, 0.29; 95% CI, 0.11 to 0.71), and patients with more-sever e DSM-III diagnoses were more likely to be detected. Physician proclivity t oward providing counseling for depression influenced the likelihood of dete ction. CONCLUSIONS: Patients' race, gender, and coexisting medical conditions affe cted physician awareness of mental health problems. Strategies to improve d etection of mental health problems among African Americans, Hispanics, and men should be explored and evaluated.