Psychosocial problems in primary care: Some results from the Dutch national study of morbidity and interventions in general practice

According to standardized screening instruments, mental distress is a common phenomenon among many patients who visit their general practitioner. However, a number of patients who seem to be in need of mental help do not put forward such a demand for help, whereas other patients who express psychosocial problems to their GP are not considered to be in need, according to a standardized measure. In this paper, a distinction has been made between the objectified needs of the patient as expressed by a standardized assessment, and the demands of the patient, expressed by the Reason for Encounter, stated during their visit at the GP. Results of a follow-up study of two cohorts of patients have been presented: one cohort presented during a 3 month period at least one articulated demand for psychosocial help, a second cohort presented at least one somatic complaint, considered by the GP as being psychological by character, without presenting any psychosocial complaint in that period. Objective needs for mental help of patients in both cohorts were assessed by means of the General Health Questionnaire. During one year all consultations of these two cohorts were registered. The following questions have been put forward: what demands for help have been put forward by the patients, what treatment have these patients got, and what has been the course of the problems during one year of patients with different needs and demands. From the results the following conclusions may be drawn: many patients with a probable mental illness (according to their objective need) present only physical symptoms. The severity of their distress however appears to be less than that of patients with a probable mental illness who do not express their psychological distress overtly. More therapeutic effort is directed at psychological symptoms than at somatic symptoms, assessed as being mainly psychosocial by character. Mental health referrals have been made almost exclusively with the former group. Within both groups, most energy is devoted to patients who are really in need, according to the General Health Questionnaire. The majority of the patients with mental health problems (be they overtly presented or not) did not present psychosocial or psychosomatic complaints anymore after a 6 month period. Recovery is higher for patients with psychological symptoms; within each group recovery is higher for patients with a low GHQ-score.