Determinants of general practitioner recognition of psychological problems in a multi-ethnic inner-city health district

Abstract

GP recognition of psychological problems varies according to patient ethnicity but can be substantially masked by both the physical and social circumstances of patients at consultation.

The characteristics of Indian subcontinent origin elders newly referred to a psychogeriatric service

“…Third, diagnostic diculties, overdiagnosis and misdiagnosis of mental illness in primary care, in this population, may lead to increased rate of referral; this hypothesis is not supported by the literature (Lindesay et al, 1997a;Shah and Dighe-Deo, 1997;Jagger, 1998;Shah et al, 1998). Moreover, in younger primary care Indian subcontinent origin patients, diagnostic diculties are oered as an explanation of lower referral rates to secondary psychiatric care (Odell et al, 1997;Jacob et al, 1998). Formal evidence in support of these hypotheses is beyond the scope of this paper and would require more ambitious epidemiological studies (Redelinghuys and Shah, 1997).…”

Clinical psychology service provision and ethnic diversity within the UK: a review of the literature

“…Conversely, while there is thought to be a greater preponderance of alcohol misuse, stressrelated/neurotic and depressive-type symptoms among south-east 'Asian' GP attendees (see, e.g., Bhui, 1999;Cochrane & Bal, 1989), there is some debate about undiagnosed rates of depression or other common mental health disorders for this ethnic group, and the subsequent impact this may have on GP referral rates to other agencies (Odell, Surtees, Wainwright, Commander, & Sashidharan, 1997;Shaukat, deBono, & Cruichskank, 1993;Smaje, 1995b;Wilson & MacCarthy, 1994). Interestingly, although cross-cultural comparisons of research in Pakistan and India appear to demonstrate that rates of depression and other common mental health disorders (e.g.…”

“…Reasons for this include variations in GP recognition rates for detecting psychological distress (Bhui, Bhugra, Goldberg, Dunn, & Desai, 2001;Odell et al, 1997;Shaw et al, 1999;Wilson & MacCarthy, 1994), different patterns in referral conventions (Commander, Sashidharan, Odell, & Surtees, 1997a;Goldberg & Huxley, 1992;Shaukat et al, 1993) and factors related more specifically to individual ethnic groups. These latter factors concern racial stereotyping and the discrimination that results from services that fail to account for the specific needs of these ethnic groups (Bhui, 2003;Commission for Health Improvement, 2003;DoH, 2003b;Nadirshaw, 1993a;Ndegwa, 1998;Sainsbury Centre for Mental Health, 2002;Sashidharan, 2003;Webb-Johnson, 1991).…”

Can a self-referral system help improve access to psychological treatments?

“…40 Even when people do attend their GP, detection rates for mental health problems are lower in ethnic minority groups. 41,42 The stigma attached to being labelled as having mental health problems appears to be particularly high in certain cultures, for example in India, where schizophrenia is associated with low marriage prospects and a fear of rejection by neighbours. 43 There are also cultural differences in beliefs towards psychological distress.…”