Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Disability and the detection of mental disorder in primary care

  • 110 Accesses

  • 25 Citations



Despite the importance of disability associated with common mental disorders, research on the detection of mental disorders in primary care has scarcely explored its relevance.


To describe the disability burden of primary care patients with common mental disorders and subthreshold disorders and to examine the association between general practitioner's (GP) recognition of mental disorder and disability.


Cross-sectional survey of GPs and their patients.


General practices in the lower North Island of New Zealand.


Participants were randomly selected: GPs (n=70) and their patients (n=3414, of whom a subset of 775 from the basis of this paper). Formal DSM-IV diagnoses were made with the Composite International Diagnostic Interview (CIDI), and psychosomatic and psychological symptoms were measured with the Somatic and Psychological Health Report. Disability was measured with the World Health Organisation's Disability Assessment Schedule-version II. GPs independently rated the severity of psychological symptoms and the presence or absence of disorder.


The principal findings were (1) that disability was associated with both mental disorder and subthreshold disorder with no significant difference in the level of disability between these categories, and (2) that GPs were less sensitive to the presence of mental disorders as defined by the CIDI if there was little concomitant disability, and in subthreshold cases, the presence of disability increased the chance of GPs identifying clinically significant symptoms.


Studies of GP recognition of mental disorder have almost exclusively adopted the perspective of concepts of disorder as defined by psychiatry. This study provides some insight into the way GPs attend to both symptoms and functioning in their assessments of psychological syndromes. Disability is an important cue to recognition of mental health problems in the primary care setting, including those that are not recognised by standardised psychiatric assessment but which may still be relevant to patient suffering.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Paykel ES, Weissman MM (1973) Social adjustment and depression. Arch Gen Psychiatry 28:659–663

  2. 2.

    Wells KB, Golding JM, Burnham MA (1988) Psychiatric disorders in a sample of the general population with and without chronic medical illness. Am J Psychiatry 145:976–981

  3. 3.

    Broadhead WE, Blazer DG, George LK, Tse CK (1990) Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 264(19):2524–2529

  4. 4.

    Von Korff M, Ormel J, Katon W, Lin EHB (1992) Disability and depression among high utilizers of health care. Arch Gen Psychiatry 49:91–100

  5. 5.

    Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T (1994) Common mental disorders and disability across cultures: results from the WHO Collaborative Study on psychological problems in general health care. JAMA 272(22):1741–1748

  6. 6.

    American Psychiatric Association A (1995) DSM IV. American Psychiatric Association, Washington, DC

  7. 7.

    Sanderson K, Andrews G (2002) Prevalence and severity of mental health-related disability and relationship to diagnosis. Psychiatr Serv 53(1):80–86

  8. 8.

    The MaGPIe Research Group (2003) The nature and prevalence of psychological problems in New Zealand primary health care: a report on Mental Health and General Practice Investigation. NZMJ 116(1171):1–15

  9. 9.

    The MaGPIe Research Group (2004) Frequency of consultation and general practitioner recognition of psychological symptoms. Br J Gen Pract 54(508):838–842

  10. 10.

    Ormel J, Koeter M, van den Brink R, Van De Willige G (1991) Recognition, management and course of anxiety and depression in general practice. Arch Gen Psychiatry 48:700–706

  11. 11.

    Pignone MP Gaynes BN, Rushton JL et al (2002) Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 136:760–764

  12. 12.

    Henkel V, Mergl R, Kohnen R, Maier W, Moller H-J, Hegerl U (2003) Identifying depression in primary care: a comparison of different methods in a prospective cohort study. BMJ 326(7382):200–201

  13. 13.

    Ormel J, Van Den Brink W, Koeter MW, Giel R, Van Der Meer K, Van De Willige G et al (1990) Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med 20(4):909–923

  14. 14.

    The MaGPIe Research Group (2004) General practitioner recognition of mental illness in the absence of a “gold standard”. Aust NZ J Psychiatry 38:789–794

  15. 15.

    Olfson M, Fireman B, Weissman MM et al (1997) Mental disorders and disability among patients in a primary care group practice. Am J Psychiatry 154:1734–1740

  16. 16.

    Wells KB, Stewart A, Hays RD, Burnam A, Rogers W, Daniels M, et al (1989) The functioning and well-being of depressed patients results: from the medical outcomes study. JAMA 262(7):914–919

  17. 17.

    Ormel J, Costa e Silva J (1995) The impact of psychopathology on disability and health perceptions. In: Ustun B, Sartorius N (eds) Mental illness in general health care: an international study. WHO Wiley, Chichester, pp 335–346

  18. 18.

    Kessler RC, DuPont RL, Berglund P, Wittchen H-U (1999) Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry 156(12)1915–1923

  19. 19.

    Wells KB, Sherbourne C (1999) Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices. Arch Gen Psychiatry 56:897–904

  20. 20.

    Andrews G, Henderson S, Hall W (2001) Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. Br J Psychiatry 178:145–153

  21. 21.

    Bijl R, Ravelli A (2000) Current and residual functional disability associated with psychopathology: findings from the Netherlands mental health Survey and Incidence Study (NEMESIS). Psychol Med 30(3):657–668

  22. 22.

    Henderson S, Korten A, Medway J (2001) Non-disabled cases in a national survey. Psychol Med 31:769–777

  23. 23.

    Spitzer R, Kroenke K, Linzer M, Hahn S et al (1995) Health related quality of life in primary care patients with mental disorders: results form the PRIME-MD 1000 Study. JAMA 274(19):1511–1517

  24. 24.

    Magruder K, Calderone G (2000) Public health consequences of different thresholds for the diagnosis of mental disorders. Compr Psychiatry 41(2):14–18

  25. 25.

    Klerman G (1989) Depressive disorders: further evidence for increased medical morbidity and impairment of social functioning. Arch Gen Psychiatry 46:856–858

  26. 26.

    Sartorius N, Ustun T, Silva J, Goldberg D, Lecrubier Y, Ormel J et al (1993) An international study of psychological problems in primary care. Arch Gen Psychiatry 50:819–824

  27. 27.

    Ustun T, Sartorius N (1995) Mental illness in general health care. Wiley, England

  28. 28.

    WHO (2000) WHODAS-II Disability Assessment Schedule Training Manual: a guide to administration. World Health Organisation, Geneva

  29. 29.

    Hickie I, Davenport T, Hadzi-Pavlovic D et al (2001) Development of a simple screening tool for common mental disorders in general practice. Med J Aust 175(Suppl):S10–S17

  30. 30.

    Kish L (1965) Survey sampling. Wiley, New York

  31. 31.

    Bebbington P, Brugha T, Meltzer H, Farrell M, Ceresa C, Jenkins R et al (2000) Psychiatric disorder and dysfunction in the UK National Survey of Psychiatric Morbidity. Soc Psychiatry Psychiatr Epidemiol 35:191–197

  32. 32.

    Goldberg D, Huxley P (1980) Mental illness in the community: the pathway to psychiatric care. Tavistock Publications Limited, London

  33. 33.

    Goldberg D (1992) A classification of psychological distress for use in primary care settings. Soc Sci Med 35:189–193

  34. 34.

    Klinkman M, Coyne J, Gallo S, Schwenk T (1998) False positives, false negatives, and the validity of the diagnosis of major depression in primary care [comment]. Arch Fam Med 7(5):451–461

  35. 35.

    Rosenberg E, Lussier M, Beaudoin C et al (2002) Determinants of the diagnosis of psychological problems by primary care physicians in patients with normal GHQ-28 scores. Gen Hosp Psychiatry 24:322–327

  36. 36.

    Solomon D, Leon A, Endicott J, Mueller T, Coryell W, Shea T et al (2004) Psychosocial impairment and recurrence of major depression. Compr Psychiatry 45(6):423–430

  37. 37.

    Ormel J, Vonkorff M, Oldehinkel AJ, Simon G, Tiemens BG, Ustun TB (1999) Onset of disability in depressed and non-depressed primary care patients. Psychol Med 29(4):847–853

  38. 38.

    Goldberg D, le Crubier Y (1995) Form and frequency of mental disorders across centres. In: Ustun B, Sartorius N (eds) Mental illness in general health care: an international study. WHO Wiley, Chichester, pp 323–334

Download references


We are grateful for the support of the participating general practitioners and other practice staff, the patients who participated, and our research staff. The Health Research Council of New Zealand funded the project (grant 99/065). Supplementary funds were also contributed by the Alcohol Advisory Council (ALAC).

Author information

Correspondence to Sunny Collings.

Additional information

The “MaGPIe” (Mental Health and General Practice Investigation) research group consists of John Bushnell, Anthony Dowell, Deborah McLeod, Clare Salmond, Stella Ramage, Sunny Collings, Pete Ellis, Marjan Kljakovic and Lynn McBain.


The Health Research Council of New Zealand funded the project (grant 99065). Supplementary funds were also contributed by the Alcohol Advisory Council (ALAC).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Collings, S. Disability and the detection of mental disorder in primary care. Soc Psychiat Epidemiol 40, 994–1002 (2005). https://doi.org/10.1007/s00127-005-0984-0

Download citation

Key words

  • primary health care
  • mental disorders
  • disability