The detection of psychological problems by General practitioners: Influence of ethnicity and other demographic variables

• Published in: Social Psychiatry and Psychiatric Epidemiology 2004-06, Vol.39 (6), p.464-471
• Main Authors: MAGINN, S, BOARDMAN, A. P, CRAIG, T. K. J, HADDAD, M, HEATH, G, STOTT, J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Demography; Diagnosis, Differential; Ethnic Groups - psychology; Ethnic Groups - statistics & numerical data; Ethnicity; Female; Health care access; Health services; Humans; Male; Medical sciences; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental health; Middle Aged; Organization of mental health. Health systems; Prevalence; Primary Health Care; Professional Competence; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychosis; Social psychiatry. Ethnopsychiatry; Sociodemographics; Surveys and Questionnaires; United Kingdom - epidemiology
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-004-0751-7

Common mental illness in Black Africans and Black Caribbeans has been relatively little studied in the UK. Previous studies of the detection of psychological problems by General Practitioners (GPs) in these groups have been inconclusive. The aim of this study was to investigate the prevalence, detection and management of psychological problems in General Practice among Black Caribbeans and Black Africans compared to White English attenders and to examine the relative contribution of other sociodemographic factors to these main outcome variables. Consecutive attenders aged 16-65 years at 18 General Practitioners in South-East London completed the General Health Questionnaire (GHQ-12) before seeing the GP. The GPs rated the current emotional state of the patients at the end of each consultation. Comparison of the GHQ and GP ratings was used to compute the detection indices. A total of 1211 patients aged 16-65 years were approached to take part in the study. Of the patients, 75 (6%) declined or were not able to complete the GHQ. In all, 994 individuals had both GP and GHQ ratings. There was an overall probable prevalence of 37%, of which 73% were identified as cases by the GPs. Black African patients had lower rates of common mental disorders, were less likely to be detected as psychiatric cases by the GP and less likely to receive active management for their psychological problems than Black Caribbean and White English patients. Rates of prevalence, detection and management were similar between Black Caribbean and White English patients. In the multivariate analysis, ethnicity, employment and age all played a significant independent role in predicting probable prevalence. The patients' reported decision to talk to their GP about psychological problems was the main predictor of detection. Ethnicity did not independently predict detection, but Black African cases were less likely to say that they would talk to their GP about psychological problems. GPs' identification indices mirrored probable prevalence, suggesting that GPs were more sensitive to detecting psychiatric illness in individuals belonging to groups which commonly presented as symptomatic. The findings suggest that in General Practice the prevalence of common mental disorders, their detection and management in Black Caribbeans are similar to those in White English, but that Black Africans have lower prevalence, are less likely to be detected and are less likely to receive active management. The stu