Psychological problems in New Zealand primary health care: a report on the pilot phase of the Mental Health and General Practice Investigation (MaGPIe)

Abstract

Aim. To carry out a pilot study in two regions in order to investigate prevalence of psychological problems in primary care in New Zealand. Method. General Practitioners (GPs) within two geographic regions were randomly selected. All adult attenders at their practice on selected days were administered a short questionnaire, the GHQ-12, which assesses the presence of psychological symptoms. The GP recorded the reasons for each consultation, and was interviewed at the end of each day about selected patients, to determine their opinion about the type of psychological problems experienced. Results. Three-quarters of selected GPs (76%) agreed to participate. 96% of patients attending their GP agreed to complete the GHQ. Scores from 385 completed GHQ Screening questionnaires suggested that 23.4% of GP patients had significant psychological symptoms. When GPs were asked about the main reason for consultation, they identified only 5.7% of current consultations as being for psychological reasons. In contrast, the GPs thought that 20.6% of patients described having some symptoms which were either mildly, moderately or completely psychological in the current consultation, and recognised that 17.4% of their patients had a mild, moderate or severe case of psychological disorder over the past twelve months. Conclusion. GPs identified one in five of their patients as having symptoms which were mildly, moderately or completely psychological, although psychological factors were the main reason for consultation in only one patient in twenty. Previous reports of very low rates of psychological problems among GP attenders in New Zealand have been thought to indicate major differences in access to health care or prevalence of common mental disorders within primary care services in this country. However, the apparently low rates of conspicuous mental disorder in New Zealand general practices may be better explained as an artifact of the type of questions asked.