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The effectiveness of case-finding for mental health problems in primary care
- Author:
- MaGPIe Research Group
- Journal article citation:
- British Journal of General Practice, 55(518), September 2005, pp.665-669.
- Publisher:
- Royal College of General Practitioners
This study explores the efficacy of screening and case-finding for high prevalence psychological disorders in routine general practice in New Zealand. Consecutive patients from a random sample of GPs were screened using the General Health Questionairre (GHQ-12). A stratified random sample of patients was selected, based on GHQ strata, and invited to participate in an indepth interview to assess their psychological health. Seventy GPs (90% response) and 775 patients (68.5% response) were included in analyses. Patients' GHQ-12 scores were compared with GP assessment of patients' psychological health using a 5-point scale of severity, and with the Composite International Diagnostic Interview (CIDI 1-month assessment). Results: Overall 17.5% of patients reached the threshold for CIDI diagnosis. GPs identified at least some psychological symptoms in the past 12 months in 70.3% of patients reaching the CIDI threshold for diagnosis. Case-finding with a 'perfect' screening instrument had the potential to identify only five new cases per 100. The sensitivity and specificity of the GHQ-12 suggest it is not an appropriate tool for case finding in a general practice setting. The study concludes that the potential value of any screening and case-finding instrument in routine general practice must be considered in the context of current high rates of identification. Where continuity of care is a feature of usual management, case-finding is most efficient when focused on patients the GP has not seen in the past year.