The diagnosis of mental disorders by the primary care physician

To determine the percentage of psychiatric disorders recognised by primary care doctors and what influence the reason for consultation exerts on the psychiatric diagnosis. A crossover study of the prevalence of psychopathology. A two-phase study was performed, with systematic sampling of one in every four visits. The GHQ-28 was used in the first phase and Goldberg's CIS in the second; a diagnosis was assigned in line with the criteria of the DSM-III-R. This diagnosis was compared with the general practitioner's, if this existed. "Maluquer Salvador" Health Centre in Girona. A sample of 400 patients between 15 and 65 who attended the centre. 2.9% were lost (2.1% in the first phase and 0.8% in the second). The GP diagnosed 36.7% of the psychiatric disorders of those attending his/her clinics, mainly because only half the patients "suggested" their problem. In 21.2% of the cases when patients "suggested" their psychopathology, they left the consultation without a diagnosis. This was particularly serious in the case of major depression. Given the high prevalence of psychopathology, the low diagnostic percentages of the general practitioner's and the difficulty the patient has in suggesting his/her problem, primary care clinics clearly require improvement in case-finding and the use of the GHQ-28 as an instrument in case-finding.