Journal of General Internal Medicine

, Volume 15, Issue 6, pp 381–388

Who is at risk of nondetection of mental health problems in primary care?


    • the Center for Chronic Disease Outcomes ResearchVeterans Affairs Medical Center
  • Lisa V. Rubenstein
    • Department of Veterans AffairsSepulveda HSR&D Field Program, Center for the Study of Healthcare Provider Behavior
  • Lisa S. Meredith
    • RAND Health Program
  • Patricia Camp
    • RAND Health Program
  • Maga Jackson-Triche
    • Department of Veterans AffairsSepulveda HSR&D Field Program, Center for the Study of Healthcare Provider Behavior
  • Kenneth B. Wells
    • RAND Health Program
    • Department of Psychiatry and Behavioral SciencesUCLA Neuropsychiatric Institute and Hospital
Original Articles

DOI: 10.1046/j.1525-1497.2000.12088.x

Cite this article as:
Borowsky, S.J., Rubenstein, L.V., Meredith, L.S. et al. J GEN INTERN MED (2000) 15: 381. doi:10.1046/j.1525-1497.2000.12088.x


OBJECTIVE: To determine patient and provider characteristics associated with increased risk of nondetection of mental health problems by primary care physicians.

DESIGN: Cross-sectional patient and physician surveys conducted as part of the Medical Outcomes Study.

PARTICIPANTS: We studied 19,309 patients and 349 internists and family physicians.

MEASUREMENTS AND MAIN RESULTS: We counted “detection” of a mental health problem whenever physicians reported, in a postvisit survey, that they thought the patient had a mental health problem or that they had counseled or referred the patient for mental health. Key independent variables included patient self-reported demographic characteristics, health-related quality of life (HRQOL), depression diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, and physician demographics and proclivity to provide counseling for depression. Logistic regression analysis, adjusted for HRQOL, revealed physicians were less likely to detect mental health problems in African Americans (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.46 to 0.86), men (OR, 0.64; 95% CI, 0.54 to 0.75), and patients younger than 35 years (OR, 0.61; 95% CI, 0.44 to 0.84), and more likely to detect them in patients with diabetes (OR, 1.4; 95% CI, 1.0 to 1.8) or hypertension (OR, 1.3; 95% CI, 1.1 to 1.6). In a model that included DSM-III diagnoses, odds of detection remained reduced for African Americans as well as for Hispanics (OR, 0.29; 95% CI, 0.11 to 0.71), and patients with more-severe DSM-III diagnoses were more likely to be detected. Physician proclivity toward providing counseling for depression influenced the likelihood of detection.

CONCLUSIONS: Patients’ race, gender, and coexisting medical conditions affected physician awareness of mental health problems. Strategies to improve detection of mental health problems among African Americans, Hispanics, and men should be explored and evaluated.

Key words

mental healthdepressionprimary carerace/ethnicity
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© Society of General Internal Medicine 2000