Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2001 Jun;51(467):456–460.

Deprivation, psychological distress, and consultation length in general practice.

A M Stirling 1, P Wilson 1, A McConnachie 1
PMCID: PMC1314026  PMID: 11407050

Abstract

BACKGROUND: Recent research has shown the benefits of longer consultations in general practice. Approximately 40% of patients presenting to general practitioners (GPs) are psychologically distressed. Studies have shown that psychological morbidity increases with increasing socioeconomic deprivation. The combined effects of psychological morbidity and socioeconomic deprivation on consultation length are unknown. In addition, though it is known that doctors correctly identify half their distressed patients as such, the effect of consultation length on identification is unknown. AIM: To examine factors associated with presentation and recognition of psychological distress in GPs' surgeries and the interaction of these factors with consultation length. DESIGN OF STUDY: A cross-sectional study. SETTING: Nine general practices in the West of Scotland, involving 1075 consultations of 21 full-time GPs. METHOD: The main outcome measures were patient psychological distress (measured by General Health Questionnaire-12), doctors' identification of psychological distress, consultation length, and Carstairs deprivation category scores. RESULTS: The mean consultation length was 8.71 minutes (SD = 4.40) and the prevalence of positive GHQ scores was 44.7%. Increasing GHQ (greater psychological distress) and lower deprivation category scores (greater affluence) were associated with longer consultations. Positive GHQ scoring increased with greater socioeconomic deprivation and also peaked in the 30 to 39 years age group. Recognition of psychological distress was greater in longer consultations (50% increase in consultation length associated with 32% increase in recognition). CONCLUSION: Increasing socioeconomic deprivation is associated with higher prevalence of psychological distress and shorter consultations. This provides further evidence to support Tudor Hart's 'inverse care law' and has implications for the resourcing of primary care in deprived areas.

Full Text

The Full Text of this article is available as a PDF (75.6 KB).

Selected References

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

  1. Andersson S. O., Mattsson B. Length of consultations in general practice in Sweden: views of doctors and patients. Fam Pract. 1989 Jun;6(2):130–134. doi: 10.1093/fampra/6.2.130. [DOI] [PubMed] [Google Scholar]
  2. Boardman A. P. The General Health Questionnaire and the detection of emotional disorder by General Practitioners. A replicated study. Br J Psychiatry. 1987 Sep;151:373–381. doi: 10.1192/bjp.151.3.373. [DOI] [PubMed] [Google Scholar]
  3. Carstairs V., Morris R. Deprivation and health in Scotland. Health Bull (Edinb) 1990 Jul;48(4):162–175. [PubMed] [Google Scholar]
  4. Corney R. H. A survey of professional help sought by patients for psychosocial problems. Br J Gen Pract. 1990 Sep;40(338):365–368. [PMC free article] [PubMed] [Google Scholar]
  5. Eachus J., Williams M., Chan P., Smith G. D., Grainge M., Donovan J., Frankel S. Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health. BMJ. 1996 Feb 3;312(7026):287–292. doi: 10.1136/bmj.312.7026.287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. 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]
  7. Goldberg D. P., Bridges K. Somatic presentations of psychiatric illness in primary care setting. J Psychosom Res. 1988;32(2):137–144. doi: 10.1016/0022-3999(88)90048-7. [DOI] [PubMed] [Google Scholar]
  8. Gunnell D. J., Peters T. J., Kammerling R. M., Brooks J. Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ. 1995 Jul 22;311(6999):226–230. doi: 10.1136/bmj.311.6999.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hart J. T. The inverse care law. Lancet. 1971 Feb 27;1(7696):405–412. doi: 10.1016/s0140-6736(71)92410-x. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. Howe A. Detecting psychological distress: can general practitioners improve their own performance? Br J Gen Pract. 1996 Jul;46(408):407–410. [PMC free article] [PubMed] [Google Scholar]
  12. Howie J. G., Heaney D. J., Maxwell M., Walker J. J., Freeman G. K., Rai H. Quality at general practice consultations: cross sectional survey. BMJ. 1999 Sep 18;319(7212):738–743. doi: 10.1136/bmj.319.7212.738. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Howie J. G., Porter A. M., Heaney D. J., Hopton J. L. Long to short consultation ratio: a proxy measure of quality of care for general practice. Br J Gen Pract. 1991 Feb;41(343):48–54. [PMC free article] [PubMed] [Google Scholar]
  14. Johnstone A., Goldberg D. Psychiatric screening in general practice. A controlled trial. Lancet. 1976 Mar 20;1(7960):605–608. doi: 10.1016/s0140-6736(76)90415-3. [DOI] [PubMed] [Google Scholar]
  15. Kessler D., Lloyd K., Lewis G., Gray D. P. Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ. 1999 Feb 13;318(7181):436–439. doi: 10.1136/bmj.318.7181.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Marks J. N., Goldberg D. P., Hillier V. F. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979 May;9(2):337–353. doi: 10.1017/s0033291700030853. [DOI] [PubMed] [Google Scholar]
  17. Vaillant G. E. Natural history of male psychologic health: effects of mental health on physical health. N Engl J Med. 1979 Dec 6;301(23):1249–1254. doi: 10.1056/NEJM197912063012302. [DOI] [PubMed] [Google Scholar]
  18. Wilkinson G., Smeeton N., Skuse D., Fry J. Consultation for physical illnesses by patients diagnosed and treated for psychiatric disorders by a general practitioner: 20 year follow up study. BMJ. 1988 Sep 24;297(6651):776–778. doi: 10.1136/bmj.297.6651.776. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. 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]
  20. Wilson A., McDonald P., Hayes L., Cooney J. Longer booking intervals in general practice: effects on doctors' stress and arousal. Br J Gen Pract. 1991 May;41(346):184–187. [PMC free article] [PubMed] [Google Scholar]
  21. Wyke S., Campbell G., Maciver S. Provision of, and patient satisfaction with, primary care services in a relatively affluent area and a relatively deprived area of Glasgow. Br J Gen Pract. 1992 Jul;42(360):271–275. [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