Background. A large proportion of a general practitioner's (GP's) caseload
comprises patients with mental health problems. It is important to ensure t
hat care is provided appropriately, on the basis of clinical need. It is th
erefore necessary to investigate the determinants of the use of mental heal
th care in the primary care sector and, in particular, to identify any non-
clinical characteristics of patients that affect the likelihood of their re
ceiving appropriate care.
Aim. To identify and compare the influence of non-clinical patient factors
on GPs' acknowledgement of mental problems and on their provision of mental
health care.
Method Cross sectional study of adults aged 16 to 65 years old (n = 802) at
tending one of eight practices (20 GPs in total) in inner west London.
Results. Multivariable analysis showed that the combination of factors that
best predict GPs' acknowledgement of the presence of mental problems are g
eneral health questionnaire (GHQ) scores (odds ratio [OR] = 1.10 per unit i
ncrease in score, 95% confidence interval [CI] = 1.07 to 1.13), previous me
ntal symptoms (OR = 7.5 95% CI = 4.3 to 129), increasing age (OR = 1.03 per
one-year increase, 95% CI = 1.01 to 1.04) and physical health status (OR =
0.98 per unit increase in short form-36 (SF-36) score, 95% CI = 0.96 to 1.
00). Multivariable analysis showed that the combination of factors that bes
t predict intervention (prescription for psychotropic medication; return vi
sit to GP; referral to psychiatric inpatients/outpatients; referral to othe
r [specified] health professionals, or social services) are previous sympto
ms (OR = 7.4, 95% CI = 3.8 to 14.4), white ethnic group (OR = 2.2 95% CI 0.
9 to 55); and not owning a property (OR = 2.1, 95% CI = 1.1 to 4.0). Life e
vents influenced intervention only in the presence of low GHQ scores (OR =
8.1, 95% CI = 2.7 to 24.0).
Conclusions. Mental problems are common in primary care and their acknowled
gement is a necessary but not a sufficient condition for intervention. Our
results show that GPs' decisions about mental health interventions can be i
nfluenced by non-clinical patient factors, regardless of patients' clinical
needs. The results suggest that current practice may not always be equitab
le, and point to the need for better understanding of the basis of these po
tential inequalities and for focused training.