Determinants of Common Mental Disorders Detection by General Practitioners in the Primary Health Care in Brazil

• Published in: International journal of psychiatry in medicine Vol. 41; no. 1; pp. 3 - 13
• Main Authors: Gonçalves, Daniel A., Fortes, Sandra, Tófoli, Luís Fernando, Campos, Mônica Rodrigues, De Jesus Mari, Jair
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2011; Baywood; Sage Publications Ltd
• Subjects: Adolescent; Adult; Age Factors; Aged; Biological and medical sciences; Brazil; Cross-Sectional Studies; Family physicians; Female; Humans; Intervention; Male; Medical diagnosis; Medical sciences; Medical screening; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental health; Middle Aged; Morbidity; Physicians, Primary Care; Prevalence; Prevention. Health policy. Planification; Primary care; Primary Health Care; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Sex Factors; Social psychiatry. Ethnopsychiatry; Studies; Surveys and Questionnaires; South America; Brazil; America; general practitioner; primary prevention; primary health care; family health; mental disorders/diagnosis; Social environment; Human; Health staff; General practitioner; Primary health care; Mental health; Prevention; Cross sectional study; Family environment; Mental disorder; Diagnosis; Detection; Public health
• DOI: 10.2190/PM.41.1.b
• EISSN: 1541-3527
• ISSN: 0091-2174

Objective:
Common Mental Disorders (CMD) are highly prevalent among patients attending primary care. Many of these disorders remain unrecognized by general practitioners (GPs), with the detection rates varying from 30 to 60%. This study aims to evaluate the CMD detection rates by Primary Heath Care (PHC) practitioners in Brazil—and factors that affect CMD detection.
Methods:
A cross sectional study was conducted with users of five PHC units in the city of Petrópolis. The CMD prevalence of psychiatric morbidity was estimated by the General Health Questionnaire-12, and the physician's CMD detection was evaluated by a questionnaire completed by GPs after each consultation.
Results:
Seven hundred and fourteen subjects participated of the study, and 400 (56%) were screened positive using GHQ-12 cut-off point of 2/3. GPs diagnosed 379 people with CMD (53.1%), and 256(36%) subjects were detected by both GHQ and the GPs with an OR of 3.04 (95%CI 2.23–4.13). CMD detection accuracy by GPs was 65%. There was a strong association between the detection of CMD and the report of medically unexplained physical symptoms by GPs. Being female, married, and a frequent service user was also related to higher detection rates.
Conclusion:
CMD detection rate was similar to those reported worldwide, but contrary to other studies, the presence of MUS increased detection rates. The high frequency of CMD in Primary Health Care highlights the need for improving GP and health worker's training in order to enable them to accurately recognize and treat psychological distress with evidence-based interventions.