Identified and unidentified mental illness in primary health care - social characteristics, medical measures and total care utilization during one year

Abstract

Objective — To screen patients in general practice with regard to identified and unidentified mental illness, and to describe social and demographic profiles of the two groups and their medical measures and total care utilization.

Design — Cross sectional study of 333 consecutive patients with one year follow-up.

Setting — Two primary health care units in a Stockholm suburb area.

Participants — Patients 18 years and older.

Main outcome measures — Mental illness according to either ICD-9 diagnosed by GPs (identified cases) or when not identified by GPs according to a self-assessment questionnaire HSCL-25 with cut-off point 1.75 (unidentified cases).

Results — In comparing identified (15.3%) and unidentified patients (11.7%) with other patients (No mental illness) no differences were found in demographic antecedents. Social problems existed in 31% of identified, 49% in unidentified, and 14% in patients with no mental illness. Sick-listing and issuing of prescriptions were more frequent in patients with identified mental illness. The one year follow-up study also showed over-utilization of care in these patients. The psychiatric services were sought by about one fifth of both the patient groups with mental illness, which is to a significantly greater extent than for patients without mental illness (2%).

Conclusion — Patients with self-assessed mental illness not identified by GPs are not deemed to be «over-medicalized» nor to overload care-services, while patients identified by GPs with a diagnosis of mental illness receive a lot of medical input and require much care. Psychosocial inputs for the latter group within primary care can presumably reduce unnecessary utilization of resources.

Key Words:

• primary health care
• mental health
• psychiatric status rating scales