Why people with probable minor psychiatric morbidity consult a doctor

Abstract

SYNOPSISThis epidemiological investigation examines factors determining medical consultation in people with probable minor psychiatric morbidity. About 54% of people with probable minor psychiatric morbidity and about 23% of the (numerically much greater) remainder with lower probability of psychiatric morbidity consulted a doctor, usually a primary care physician, in the two weeks prior to a research interview. Medical consultation rates were higher in females than in males.The dominant finding was that in people with probable minor psychiatric morbidity physical illness was strongly associated with medical consultation. Almost 89% of males and 97% of females with probable minor psychiatric morbidity and physical illness consulted a doctor in the two weeks prior to interview. Logistic regression modelling was used to investigate the joint effects on medical consultation of physical illness and six socio-demographic variables, and physical illness emerged as the major single determinant of medical consultation in women and, in men, it exerted its effect through an interaction with lower educational level.

Social problems as factors affecting medical consultation: a comparison between general practice attenders and community probands with emotional distress

“…However, in this study comparisons were performed on samples stratified by attendance rate, not allowing a direct confrontation with our findings. Vazquez-Barquero et al (1992) investigated the joint effects of physical illness and sociodemographic variables on medical consultation by subjects with emotional distress, and found that physical illness emerged as the major single determinant of medical consultation in women, while in men it exerted its effect through an interaction with lower educational level. It was an unexpected finding that, in our study, physical health status was not confirmed by logistic regression analysis as a predictor of GP consultation.…”

“…It was an unexpected finding that, in our study, physical health status was not confirmed by logistic regression analysis as a predictor of GP consultation. This discrepancy might be due to the stricter criteria used by Vazquez-Barquero et al (1992) as they rated only current physical illness of a non-transient nature (in fact, the majority of selected subjects reported chronic diseases); furthermore, although they selected subjects who scored over the threshold for 'caseness' on the GHQ, the GHQ score was not included in logistic regression analysis as a controlling variable.…”

“…On the other hand, it has long been recognized that patients suffering from emotional disorder in general practice also present higher levels of physical illness and social dysfunction (Shepherd et al 1966). Although illness severity is prominent in determining self-referral (Ingham & Miller, 1983;Vazquez-Barquero et al 1992), a patient's social circumstances often interact to influence the symptom perception and appraisal and to determine whether an individual will consult a doctor. In this respect, Mechanic (1979) has drawn attention to the contrast between the findings obtained from large-scale surveys and those that result from smaller-scale studies in which sociocultural, organizational and psychosocial factors were shown to be equally important in affecting the lay definition of illness and the decision to consult a physician.…”

Absence of social networks, social support and health services utilization

“…Most research that adopts some version of this model has shown the importance of ' illness ' in studies of health services utilization (Bice et al 1972 ;Hershey et al 1975 ;Berki & Kobashigawa, 1976 ;Wolinsky, 1976 ;Kronenfeld, 1978 ;Va! zquez-Barquero et al 1992 ;Adler et al 1993 ;Feinstein, 1993 ;Goldberg, 1995, Himmelstein & Woolhandler 1995.…”

Patient-directed gaze as a tool for discovering and handling psychosocial problems in general practice

“…They usually do not need much encouragement to talk about somatic problems but are often reluctant to talk about nonmedical matters, either because they expect the doctor not to be interested in these matters, because of embarrassment and the fear of appearing foolish, or because of real anxiety about the possible significance of the symptoms (Roter & Hall, 1992). Even patients with serious psychological distress only present somatic problems during the consultation (Katon, Korff, &von Lin, 1990;Vasquez-Barquero, Diez Manrique, & Gaite, 1992;Verhaak & Tijhuis, 1994). As a consequence, general practitioners often do not recognize the patient's psYchosocial problems (Goldberg & Bridges, 1987;Ormel, van den Brink, & Koeter, 1990;Skuse & Williams, 1984)..This may lead to patient dissatisfaction, noncompliance, and even worsening health (Cassell, 1991;Roter & Hall, 1992;White, 1988).…”