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PubMed2005

Consultation for and identification of child and adolescent psychological problems in Dutch general practice.

BACKGROUND: Child and adolescent psychological problems are rarely brought to the attention of GPs. Children and adolescents with psychological problems who do visit their GP are seldom identified as such by GPs. OBJECTIVE: To investigate in a general population sample of 2,449 Dutch children and adolescents (4-17 years) GP consultation and GP diagnoses of child psychological problems, and the influence of child and family characteristics upon these variables. METHODS: The degree to which parent, teacher, and adolescent reports of the presence of child psychological problems are in concordance with GP diagnoses of these problems was determined. Logistic regression analyses were used to examine correlates of GP consultation and psychological diagnoses. RESULTS: Approximately 80% of children and adolescents with psychological problems had visited their GP within the preceding year. GP consultation was most strongly associated with child/adolescent chronic physical disorders. Concordance between GP psychological diagnoses and parent, teacher, and adolescent reports of psychological problems was limited. Children and adolescents with psychological problems according to parent or teacher report, children with school problems, young boys, adolescents with negative health perceptions, and adolescents from single parent families were more likely to be diagnosed with psychological problems by GPs. CONCLUSION: Improving GPs' interview techniques, introducing standardised screening measures in general practice, increasing GPs' awareness of the possible presence of psychological problems in children consulting for physical problems, and strengthening collaboration between GPs and mental health professionals may increase GP identification of child psychological problems and enhance access to care for those in need.

Adolescent↗
PubMed1988

Psychological problems in general practice patients: two assumptions explored.

Research is needed into the scientific basis for psychologists' 'specialist' model of service to general practitioners. This study evaluated two predictions of this service to general practitioners. This study evaluated two predictions of this model: firstly, that patients with psychological problems can be identified reliably; secondly, that they tax GPs' resources and ability disproportionately. To test these, psychologists observed 448 GP consultations. The GP and psychologist independently rated the involvement of psychological factors; the GP recorded his satisfaction with, and the psychologist the duration of, the consultation. Patients completed scales of psychiatric and social dysfunction. Both predictions were confirmed. Agreement between GPs' and psychologists' ratings of the presence of psychological factors was higher than reported previously, and not explained by the small correlation of psychiatric morbidity with each. Problems identified by GPs as psychological were associated with longer, repeated and less satisfying consultations.

Adult↗
PubMed1996

Psychological treatment of emotional problems by general practitioners.

Since the pioneering work of Balint (1964; Balint & Norell, 1973) there has been little empirical study of general medical practitioners' psychological treatment of patients presenting with emotional problems. In this study 88 patients presenting to GPs for help with emotional problems were interviewed at home about their experiences of their consultations with the GPs. Their audiotaped consultations were then analysed using four different coding systems: a content coding system devised for the study, two verbal response mode systems (Byrne & Long, 1976; Stiles, 1982), and ratings of the doctor's empathic understanding and concern and warmth. Less than half the average consultation was found to comprise psychological treatment broadly defined as any discussion and listening to patients' psychosocial concerns. Although psychological treatment generally was associated with positive patient experiences, the strongest effects found were for listening interactions (where patients described their problems in their own words with non-directive encouragement from the doctor) and for rated doctor empathy. The results are discussed in relation to the work of Balint (1964) and associated findings in empirical studies of psychotherapy.

Adolescent↗
PubMed1963

GRADIENTS OF AUDITORY GENERALIZATION FOR BLIND, RETARDED CHILDREN.

Severely retarded, blind children were conditioned to respond differentially to two intensities of a pure tone. Gradients of auditory generalization were obtained that were reliable and similar to those for normal adults, but often asymmetric and non-monotonic.

Adult↗
PubMed2004

Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries.

BACKGROUND: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. METHODS: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, The Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. RESULTS: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. CONCLUSIONS: Health care system characteristics do affect GPs' performance in psycho-social care.

Europe↗