Predictors of accuracy of recognition of emotional distress in general practice

ABSTRACT : This study sought to determine factors associated with general practitioner (GP) recognition of emotional distress in Australian general practice. Methods: Twenty eight GPs completed a clinical audit in which they noted their identification of any emotional distress in their patients, while 868 of their patients completed the General Health Questionnaire (GHQ-28). The GHQ was scored with the conventional 4/5 cut-off. GP recognition was determined by a comparison of the GP record of emotional distress and the patient GHQ. Logistic regression was used to examine which patient and GP characteristics influenced correct recognition. Results: The GHQ identified 48% of all patients as probable cases. GPs identified 34% of their patients as having emotional distress, correctly recognizing 43% of GHQ cases. Overall, specificity was high (81%), though sensitivity was modest (43%). For individual GPs the rate of correct recognition varied considerably, from 4% to 100%. Correct recognition was associated with years experience as a GP, older age of patient and greater severity of distress. Conclusions: The data raise questions about the possible oversensitivity of the GHQ. The clinical skills associated with the recognition of mental illness and of emotional distress are obviously complex, and take time and experience to develop. Reassuringly, GPs are recognising most of the more severe depressions.