Psychological Medicine



Unequal access and unmet need: neurotic disorders and the use of primary care services


P. E. BEBBINGTON a1c1, H. MELTZER a1, T. S. BRUGHA a1, M. FARRELL a1, R. JENKINS a1, C. CERESA a1 and G. LEWIS a1
a1 Department of Psychiatry and Behavioural Sciences, RF & UCL Medical School, Institute of Psychiatry and Office for National Statistics, London; Department of Psychiatry, University of Leicester; Ninewells Hospital and Medical School, Dundee; and University of Wales College of Medicine, Department of Psychological Medicine, Cardiff

Abstract

Background. In this paper we use data from the National Survey of Psychiatric Morbidity to examine how many people with neurotic disorders receive professional evaluation, and how this is affected by clinical and sociodemographic differences. We hypothesized that psychiatric symptoms and attendant dysfunctions would both have an effect on contacting, and that key demographic variables would not.

Method. The household component of the British National Surveys of Psychiatric Morbidity was based on a random sample of > 10000 subjects. Psychiatric symptoms and ICD-10 diagnosis were established by lay interviewers using the CIS-R. Social dysfunction was tapped by asking about difficulties in performing seven types of everyday activity. We examined symptom score, ADL deficit score and demographic variables in relation to contact with primary care physicians for psychiatric symptoms.

Results. The major determinant of contacting a primary care physician was severity, mainly due to the level of psychiatric symptoms, but with an independent contribution from social dysfunction. There were also significant contributions from sex, marital status, age, employment status and whether the subject had a physical condition as well.

Conclusions. The major influence on whether people seek the help of their family doctors for mental health problems is the severity of disorder. Although there are some social inequalities in access to family doctors, these are less important. The most salient finding from our study is that even people suffering from high levels of psychiatric symptoms very often do not have contact with professionals who might help them.


Correspondence:
c1 Address for correspondence: Professor Paul E. Bebbington, RF & UCL London Medical School, Department of Psychiatry and Behavioural Sciences, Archway Campus, Whittington Hospital, Highgate Hill, London N19 5NF.


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