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Who talks to physicians about mental health and substance abuse problems?

Journal of General Internal Medicine volume 3, pages 363–369 (1988)Cite this article

Abstract

This is an analysis of data from the NIMH-sponsored Epidemiologic Catchment Area community-based study, investigating who reported discussing mental health or substance abuse problems with nonpsychiatric physicians. Data were from 7,092 respondents in four sites, all of whom had received care only in the nonpsychiatric sector in the previous six months. A multiple logistic model found that those individuals who had psychiatric disorders, and female, middle-aged, and Hispanic respondents, were more likely to have discussed emotional or mental health problems with their physicians. Respondents with alcohol abuse and substance abuse disorders did not report any more discussion of mental health problems than did respondents without alcohol or substance abuse disorders. Only 36% of the respondents who said they had discussed mental health problems were found to have psychiatric disorders by the Diagnostic Interview Survey (DIS), but many of those without disorders reported more anxiety symptoms. An analysis was done to predict which respondents with DIS-defined psychiatric disorders did not report discussing mental health problems with their nonpsychiatric physicians. Those less than 35 years of age, those older than 65 years of age, males, and those with only one recent visit to a provider were statistically at high risk for not discussing their psychiatric problems.

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References

  1. Shapiro S, Skinner EA, Kessler LG, et al. Utilization of health and mental health services. Arch Gen Psychiat 1984;41:971–8.

    PubMed  CAS  Google Scholar 

  2. Kamerow DB, Pincus HA, Macdonald DI. Alcohol abuse, other drug abuse, and mental disorders in medical practice: prevalence, costs, recognition, and treatment. JAMA 1986;255:2054–7.

    Article  PubMed  CAS  Google Scholar 

  3. Hoeper EW, Nycz GR, Turner RW, et al. Estimated prevalence of RDC mental disorder in primary medical care. Int J Ment Health 1979;8:6–15.

    Google Scholar 

  4. Kessler LG, Burns BJ, Shapiro S, et al. Psychiatric diagnoses of medical service users: evidence from the Epidemiological Catchment Area Program. Am J Public Health 1987;77:18–24.

    PubMed  CAS  Google Scholar 

  5. Von Korff M, Shapiro S, Burke JD, et al. Anxiety and depression in a primary care clinic: comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessments. Arch Gen Psychiat 1987;44:152–6.

    Google Scholar 

  6. Shapiro S, German PS, Turner RW, et al. Secondary prevention with adult patients in primary care settings. Final Report for NIMH Contract No. 278-81.0025 (DB). Rockville, MD, National Institute of Mental Health, 1983.

    Google Scholar 

  7. Bridges K, Goldberg D. Somatic presentation of DSM-III psychiatric disorders in primary care. J Psychosomat Res 1985;29:563–9.

    Article  CAS  Google Scholar 

  8. Mechanic D, ed. Symptoms; illness behavior and helpseeking. New York: Prodist, 1982.

    Google Scholar 

  9. Leaf PJ, Livingston MM, Tischler GL, et al. Contact with health professionals for the treatment of psychiatric and emotional problems. Med Care 1985;23:1322–37.

    Article  PubMed  CAS  Google Scholar 

  10. Goldberg D, Steele JJ, Johnson A, et al. Ability of primary care physicians to make accurate ratings of psychiatric symptoms. Arch Gen Psychiat 1982;39:829–33.

    PubMed  CAS  Google Scholar 

  11. Coulehan JL, Zettler-Segal M, Block M, et al. Recognition of alcoholism and substance abuse in primary care patients. Arch Intern Med 1987;147:349–52.

    Article  PubMed  CAS  Google Scholar 

  12. Regier DA, Myers JK, Kramer M, et al. The NIMH Epidemiologic Catchment Area (ECA) program: historical context, major objectives, and study population characteristics. Arch Gen Psychiat 1984;41:934–9

    PubMed  CAS  Google Scholar 

  13. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule, its history, characteristics, and validity. Arch Gen Psychiat 1981;38:381–9.

    PubMed  CAS  Google Scholar 

  14. Anthony JC, Folstein MF, Romanowski AJ, et al: Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis: experience in eastern Baltimore. Arch Gen Psychiat 1985;42:667–75.

    PubMed  CAS  Google Scholar 

  15. Helzer JE, McEvoy LT, Robins LN, et al. A comparison of clinical and Diagnostic Interview Schedule diagnoses: physician reexamination of lay-interviewed cases in the general population. Arch Gen Psychiat 1985;42:657–66.

    PubMed  CAS  Google Scholar 

  16. Eaton WW, Kessler LG, eds. Epidemiological field methods in psychiatry: the NIMH Epidemiologic Catchment Area Program. Orlando: Academic Press, 1985.

    Google Scholar 

  17. Kamerow DB, Ford DE, Burns BJ. Prevalence and characteristics of mental disorders in the general medical sector. Presented at the 115th Annual Meeting of the American Public Health Association, New Orleans, Oct 22, 1987.

  18. Shah BV. SESUDAAN: standard errors program for computing of standardized rates from sample survey data. RTI/5250/00-01S, Research Triangle, NC: Research Triangle Institute, 1981.

    Google Scholar 

  19. Shah BV, Folsom RE, Harrell FE, Dillard CN. Survey data analysis software for logistic regression. Research Triangle, NC: Research Triangle Institute, 1984.

    Google Scholar 

  20. Moore RD, Molitz FE. Underdiagnosis of alcoholism by residents in an ambulatory medical practice. J Med Educ 1986;46–52.

  21. Bush B, Shaw S, Cleary P, et al. Screening for alcohol abuse using the CAGE questionnaire. Am J Med 1987;82:231–5.

    Article  PubMed  CAS  Google Scholar 

  22. German PS, Shapiro S, Skinner EA, et al. Detection and management of mental health problems of older patients by primary care providers. JAMA 1987;257:489–93.

    Article  PubMed  CAS  Google Scholar 

  23. Boardman AP. The General Health Questionnaire and the detection of emotional disorders by general practitioners. Br J Psychiat 1987;151:373–81.

    Article  CAS  Google Scholar 

  24. Good MJ, Good BJ, Cleary PD. Do patient attitudes influence physician recognition of psychosocial problems in primary care? J Fam Pract 1987;25:53–9.

    PubMed  CAS  Google Scholar 

  25. Davenport S, Goldberg D, Millan T. How psychiatric disorders are missed during medical consultation. Lancet 1987;ii:439–41.

    Article  Google Scholar 

  26. Rucker L, Frye EB, Cygan RW. Feasibility and usefulness of depression screening in medical outpatients. Arch Intern Med 1986;146:729–31.

    Article  PubMed  CAS  Google Scholar 

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Author information

Author notes

  1. James W. Thompson MD, MPH

    Present address: the Department of Psychiatry, University of Maryland, Baltimore, Maryland

Authors and Affiliations

  1. Primary Care Research Program, National Institute of Mental Health, Rm 18C-14, 5600 Fishers Lane, 20857, Rockville, MD

    Daniel E. Ford MD, MPH

Authors
  1. Daniel E. Ford MD, MPH
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  2. Douglas B. Kamerow MD, MPH
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  3. James W. Thompson MD, MPH
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Additional information

Received from the Primary Care Research Program, National Institute of Mental Health, Rockville, Maryland.

The Epidemiologic Catchment Area Program is a series of five epidemiologic research studies performed by independent research teams in collaboration with staff of the Division of Clinical Research (DCR) of the National Institute of Mental Health (NIMH). The NIMH principal collaborators are Darrel A. Regier, MD, MPH, Ben Z. Locke, MSPH, and Jack D. Burke, Jr., MD, MPH; the NIMH Project Officer is William J. Huber. The Principal Investigators and Co-Investigators from the five sites are: Yale University (supported by cooperative agreement U01 MH 34224) — Jerome K. Myers, PhD, Myrna M. Weissman, PhD, and Gary Tischler, MD; Johns Hopkins University (supported by cooperative agreement U01 MH 33870) — Morton Kramer. ScD. Sam Shapiro, and Shepard Kellam, MD; Washington University (supported by cooperative agreement U01 MH 33883) — Lee N. Robins, PhD, and John Helzer, MD; Duke University (supported by cooperative agreement U01 MH 35386) — Linda George, PhD, and Dan Blazer, MD, PhD; University of California, Los Angeles (supported by cooperative agreement U01 MH 35865) — Marvin Karno, MD, Richard Hough, PhD, Javier Escobar, MD, Audrey Burnam, PhD, and Diane Timbers, PhD.

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Ford, D.E., Kamerow, D.B. & Thompson, J.W. Who talks to physicians about mental health and substance abuse problems?. J Gen Intern Med 3, 363–369 (1988). https://doi.org/10.1007/BF02595795

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  • DOI: https://doi.org/10.1007/BF02595795

Key words

  • primary care
  • mental health services
  • mental disorders
  • patient participation
  • alcoholism