Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1999 Nov;49(448):875–879.

Patients' reasons for not presenting emotional problems in general practice consultations.

J Cape 1, Y McCulloch 1
PMCID: PMC1313556  PMID: 10818651

Abstract

BACKGROUND: Patients commonly do not mention emotional problems in consultations, and this is a factor in general practitioners' (GPs') difficulty in identifying psychological morbidity. AIM: To investigate patients' self-reported reasons for not disclosing psychological problems in consultations with GPs. METHOD: From nine general practices, a sample of patients with high General Health Questionnaire scores, who planned to present only somatic symptoms to the GP, were interviewed after their consultation with the GP. The interview covered their reasons for not mentioning emotional problems. A patient satisfaction questionnaire was administered. RESULTS: A total of 83 patients were interviewed. Sixty-four patients confirmed that they had not mentioned emotional problems in the consultation; 23 (36%) of these gave primarily realistic reasons for not presenting emotional problems (e.g. able to cope with distress), 29 (45%) gave reasons related to psychological embarrassment or hesitation to trouble the GP, and 12 (19%) were mainly deterred by the doctors' interview behaviours. The latter group had significantly lower satisfaction scores than patients in the other two groups. In addition, patients in all groups commonly reported perceptions of lack of time (48%) and that there is nothing doctors can do to help (39%) as barriers to mentioning emotional problems. CONCLUSION: An understanding of patients' reasons for not disclosing emotional problems can assist in identifying subgroups of patients with different management needs.

Full Text

The Full Text of this article is available as a PDF (50.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bridges K. W., Goldberg D. P. Somatic presentation of DSM III psychiatric disorders in primary care. J Psychosom Res. 1985;29(6):563–569. doi: 10.1016/0022-3999(85)90064-9. [DOI] [PubMed] [Google Scholar]
  2. Bridges K., Goldberg D., Evans B., Sharpe T. Determinants of somatization in primary care. Psychol Med. 1991 May;21(2):473–483. doi: 10.1017/s0033291700020584. [DOI] [PubMed] [Google Scholar]
  3. Cape J. D. Psychological treatment of emotional problems by general practitioners. Br J Med Psychol. 1996 Jun;69(Pt 2):85–99. doi: 10.1111/j.2044-8341.1996.tb01854.x. [DOI] [PubMed] [Google Scholar]
  4. Coyne J. C., Schwenk T. L., Fechner-Bates S. Nondetection of depression by primary care physicians reconsidered. Gen Hosp Psychiatry. 1995 Jan;17(1):3–12. doi: 10.1016/0163-8343(94)00056-j. [DOI] [PubMed] [Google Scholar]
  5. Coyne J. C., Schwenk T. L. The relationship of distress to mood disturbance in primary care and psychiatric populations. J Consult Clin Psychol. 1997 Feb;65(1):161–168. doi: 10.1037//0022-006x.65.1.161. [DOI] [PubMed] [Google Scholar]
  6. Davenport S., Goldberg D., Millar T. How psychiatric disorders are missed during medical consultations. Lancet. 1987 Aug 22;2(8556):439–441. doi: 10.1016/s0140-6736(87)90970-6. [DOI] [PubMed] [Google Scholar]
  7. Freeling P., Rao B. M., Paykel E. S., Sireling L. I., Burton R. H. Unrecognised depression in general practice. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1880–1883. [PMC free article] [PubMed] [Google Scholar]
  8. Gask L., McGrath G., Goldberg D., Millar T. Improving the psychiatric skills of established general practitioners: evaluation of group teaching. Med Educ. 1987 Jul;21(4):362–368. doi: 10.1111/j.1365-2923.1987.tb00377.x. [DOI] [PubMed] [Google Scholar]
  9. Girón M., Manjón-Arce P., Puerto-Barber J., Sánchez-García E., Gómez-Beneyto M. Clinical interview skills and identification of emotional disorders in primary care. Am J Psychiatry. 1998 Apr;155(4):530–535. doi: 10.1176/ajp.155.4.530. [DOI] [PubMed] [Google Scholar]
  10. Goldberg D. P., Jenkins L., Millar T., Faragher E. B. The ability of trainee general practitioners to identify psychological distress among their patients. Psychol Med. 1993 Feb;23(1):185–193. doi: 10.1017/s0033291700038976. [DOI] [PubMed] [Google Scholar]
  11. Hansen J. P., Bobula J., Meyer D., Kushner K., Pridham K. Treat or refer: patients' interest in family physician involvement in their psychosocial problems. J Fam Pract. 1987 May;24(5):499–503. [PubMed] [Google Scholar]
  12. Hirschfeld R. M., Keller M. B., Panico S., Arons B. S., Barlow D., Davidoff F., Endicott J., Froom J., Goldstein M., Gorman J. M. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA. 1997 Jan 22;277(4):333–340. [PubMed] [Google Scholar]
  13. Howe A. "I know what to do, but it's not possible to do it"--general practitioners' perceptions of their ability to detect psychological distress. Fam Pract. 1996 Apr;13(2):127–132. doi: 10.1093/fampra/13.2.127. [DOI] [PubMed] [Google Scholar]
  14. Katon W. Will improving detection of depression in primary care lead to improved depressive outcomes? Gen Hosp Psychiatry. 1995 Jan;17(1):1–2. doi: 10.1016/0163-8343(94)00055-i. [DOI] [PubMed] [Google Scholar]
  15. Kirmayer L. J., Robbins J. M., Dworkind M., Yaffe M. J. Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry. 1993 May;150(5):734–741. doi: 10.1176/ajp.150.5.734. [DOI] [PubMed] [Google Scholar]
  16. Klinkman M. S. Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry. 1997 Mar;19(2):98–111. doi: 10.1016/s0163-8343(96)00145-4. [DOI] [PubMed] [Google Scholar]
  17. Klinkman M. S., Coyne J. C., Gallo S., Schwenk T. L. False positives, false negatives, and the validity of the diagnosis of major depression in primary care. Arch Fam Med. 1998 Sep-Oct;7(5):451–461. doi: 10.1001/archfami.7.5.451. [DOI] [PubMed] [Google Scholar]
  18. Murray J., Corney R. Not a medical problem? An intensive study of the attitudes and illness behaviour of low attenders with psychosocial difficulties. Soc Psychiatry Psychiatr Epidemiol. 1990 May;25(3):159–164. doi: 10.1007/BF00782746. [DOI] [PubMed] [Google Scholar]
  19. Ormel J., Koeter M. W., van den Brink W., van de Willige G. Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry. 1991 Aug;48(8):700–706. doi: 10.1001/archpsyc.1991.01810320024004. [DOI] [PubMed] [Google Scholar]
  20. Raynes N. V., Cairns V. Factors contributing to the length of general practice consultations. J R Coll Gen Pract. 1980 Aug;30(217):496–498. [PMC free article] [PubMed] [Google Scholar]
  21. Shepherd M., Wilkinson G. Primary care as the middle ground for psychiatric epidemiology. Psychol Med. 1988 May;18(2):263–267. doi: 10.1017/s0033291700007807. [DOI] [PubMed] [Google Scholar]
  22. Sims A. The scar that is more than skin deep: the stigma of depression. Br J Gen Pract. 1993 Jan;43(366):30–31. [PMC free article] [PubMed] [Google Scholar]
  23. Tylee A. T., Freeling P., Kerry S. Why do general practitioners recognize major depression in one woman patient yet miss it in another? Br J Gen Pract. 1993 Aug;43(373):327–330. [PMC free article] [PubMed] [Google Scholar]
  24. Tylee A., Freeling P., Kerry S., Burns T. How does the content of consultations affect the recognition by general practitioners of major depression in women? Br J Gen Pract. 1995 Nov;45(400):575–578. [PMC free article] [PubMed] [Google Scholar]
  25. Weich S., Lewis G., Donmall R., Mann A. Somatic presentation of psychiatric morbidity in general practice. Br J Gen Pract. 1995 Mar;45(392):143–147. [PMC free article] [PubMed] [Google Scholar]
  26. Wells J. E., Robins L. N., Bushnell J. A., Jarosz D., Oakley-Browne M. A. Perceived barriers to care in St. Louis (USA) and Christchurch (NZ): reasons for not seeking professional help for psychological distress. Soc Psychiatry Psychiatr Epidemiol. 1994 Jul;29(4):155–164. doi: 10.1007/BF00802012. [DOI] [PubMed] [Google Scholar]
  27. Williams S. J., Calnan M. Key determinants of consumer satisfaction with general practice. Fam Pract. 1991 Sep;8(3):237–242. doi: 10.1093/fampra/8.3.237. [DOI] [PubMed] [Google Scholar]
  28. Wilson A. Consultation length in general practice: a review. Br J Gen Pract. 1991 Mar;41(344):119–122. [PMC free article] [PubMed] [Google Scholar]
  29. Wolf M. H., Putnam S. M., James S. A., Stiles W. B. The Medical Interview Satisfaction Scale: development of a scale to measure patient perceptions of physician behavior. J Behav Med. 1978 Dec;1(4):391–401. doi: 10.1007/BF00846695. [DOI] [PubMed] [Google Scholar]
  30. Wright A. F. A study of the presentation of somatic symptoms in general practice by patients with psychiatric disturbance. Br J Gen Pract. 1990 Nov;40(340):459–463. [PMC free article] [PubMed] [Google Scholar]
  31. Wright A. F. Unrecognized psychiatric illness in general practice. Br J Gen Pract. 1996 Jun;46(407):327–328. [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES