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Psycho-social problem disclosure during primary care consultation

Published online by Cambridge University Press:  11 October 2011

Lidia Del Piccolo
Lidia Del Piccolo*
Affiliation:
Dipartimento di Medicina e Sanità Pubblica, Servizio di Psicologia Medica, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dott.ssa Lidia Del Piccolo, Dipartimento di Medicina e Sanità Pubblica, Servizio di Psicologia Medica, Ospedale Policlinico, 37134 Verona. Fax: +39-045-585871 E-mail: [email protected]
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Summary

Objective – To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure. Design – «Case control». Cases had a GHQ–12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness. Setting – Six single handed primary care practices. Measures – Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index. Results – The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems. Conclusions – The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.

Riassunto

Scopo – Valutare come i pazienti trattano tematiche psicosociali durante la consultazione in medicina generale e se vi è un'influenza degli aspettà di personalità (dipendenza emotiva e tendenza a controllare o delegare la salute) su tale comportamento. Disegno — “Caso-controllo”. Tra i casi rientravano coloro che avevano punteggio maggiore o uguale a tre nel General Health Questionnaire (GHQ—12). L'appaiamento caso—controllo è stato fatto sulla base del medico curante, del giudizio di presenza/assenza di disagio emotivo espresso dal medico, dal sesso, dall'età e dalla presenza di malattia cronica. Setting — Sei ambulatori di Medicina Generale. Principali misure utilizzate — Scheda del medico con i dati clinici del paziente, Scheda del paziente con dati socio—demografici, Questionario sui problemi sociali, GHQ—12, Questionario sugli eventi di vita. Successivamente i pazienti sono stati ricontattati ed hanno compilato la Multidimensional Health Locus of Control Scale (MHLC), l'Interpersonal Dependency Inventory e il Social Support Questionnaire. Risultati – La probabilità di trattare tematiche psicosociali aumenta quando il medico attribuisce disagio psichico. I pazienti correttamente identificati senza disagio emotivo hanno trattato meno frequentemente temi psico-sociali, pur accennandoli, il contrario si è verificato per i pazienti riconosciuti con disagio. I pazienti con alto punteggio al GHQ-12 e non identificati dal medico (falsi negativi), più degli altri non hanno neppure fatto cenno ad aspetti psicosociali. La presentazione di problemi psicosociali non è risultata influenzata dalle misure di personalità. Conclusioni – L'assenza di accenni a temi psicosociali e la mancanza di un approccio centrato sul paziente hanno contribuito al non riconoscimento del disagio emotivo nei pazienti «falsi negativi». Un atteggiamento attivo da parte del medico nell'introdurre tematiche psicosociali può avere un notevole effetto sul riconoscimento del disagio psichico in tali pazienti.

Keywords

doctor-patient communicationpatient-centred communicationemotional distress identificationcomunicazione medico-pazienteintervista centrata sul pazientericonoscimento del disagio emotivo.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 9 , Issue 4 , December 2000 , pp. 257 - 271
Copyright
Copyright © Cambridge University Press 2000

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References

Bibliografia

Archer, R.P. & Kutash, P. (1982). Anxiety response to psychological feed back among psychiatric inpatients. Psychological Reports 50, 547–551.CrossRefGoogle Scholar
Beisecker, A.E. & Beiseker, T.D. (1990). Patient information-seeking behaviours when communicating with doctors. Medical Care 1, 19–28.CrossRefGoogle Scholar
Bellantuono C, Fiorio, R., Zanotelli, R. & Tansella, M. (1987). Psychiatric screening in general practice in Italy. Social Psychiatry 22, 113–117.Google Scholar
Birtchnell, J., Deahl, M. & Falkowski, J. (1991). Further exploration of the relationship between depression and dependence. Journal of Affective Disorders 22, 221–233.CrossRefGoogle ScholarPubMed
Bloom, J.R. (1979). Psychological Measurement and specific hypothesis, research note. Journal of Consulting and Clinical Psychology 47, 637–639.Google Scholar
Bomstein, R.F. (1993). The Dependent Personality. New York, Guilford Press.Google Scholar
Bower, P., West, R., Tylee, A. & Hann, M. (1999). Patients' perceptions of the role of the general practitioner in the management of emotional problems. British Journal of Health Psychology 4, 41–52.CrossRefGoogle Scholar
Brown, J.B. & Siegel, J.M. (1988). Attributions for negative life events and depression, the role of perceived control. Journal of Personality and Social Psychology 54, 316–332.CrossRefGoogle ScholarPubMed
Brown, G.W., Adler, Z. & Bifulco, A. (1988) Life events, difficulties and recovery from chronic depression. British Journal of Psychiatry 152, 487–498.CrossRefGoogle ScholarPubMed
Brown, J.B., Steward, M. & Tessier, S. (1995). Assessing Communication Between Patients and Doctors, a Manual for Scoring Patientcentred Communication. CSFM Working Papers Series: Montreal.Google Scholar
Brugha, T., Bebbington, P., Tennant, C. & Hurry, J. (1985). The List of Threatening Experiences, a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189–194.CrossRefGoogle ScholarPubMed
Bucholz, K.K. & Robins, L.N. (1987) Who talks to a doctor about existing depressive illness? Journal of Affective Disorders 12, 241–250.Google Scholar
Butow, P.N., Dunn, S.M., Tattersall, M.H.N. & Jones, Q.J. (1995). Computer-based interaction analyses of the cancer consultation. British Journal of Cancer 71, 1115–21.Google Scholar
Cameron, L., Leventhal, E. & Leventhal, H. (1995). Seeking medical care in response to symptoms and life stress. Psychosomatic Medicine 57, 37–47.CrossRefGoogle ScholarPubMed
Carter, W.B., Inui, T.S., Kukull, W.A. & Haigh, V.H. (1982). Outcomebased doctor-patient interaction analysis. Identifying effective provider and patient behavior. Medical Care 6, 550–566.CrossRefGoogle Scholar
Casey, P.R., Tyrer, P.J. & Platt, S. (1985). The relationship between social functioning and psychiatric symptomatology in primary care. Social Psychiatry 20, 5–9.CrossRefGoogle ScholarPubMed
Chen, C., Liang, Y. & Hsieh, W. (1989). Evaluation of clinical diagnosis and stressful life events in patients at a rural family practice center. Family Practice 6, 259–262.Google Scholar
Copin, G. & Even, T.S. (1993). An integrated approach to preserve patients from doctors. Australian and New Zealand Journal of Psychiatry 25, 38–43.Google Scholar
Comey, R.H. & Clare, A.W. (1985). The construction, development and testing of a self-report questionnaire to identify social problems. Psychological Medicine 15, 637–649.Google Scholar
Del Piccolo, L., Saltini, A. & Zimmermann, Ch. (1998) Which patients talk about stressful life events and social problems to the General Practitioner? Psychological Medicine 6, 1289–1299.CrossRefGoogle Scholar
Del Piccolo, L., Benpensanti, G., Bonini, P., Cellerino, P., Saltini, A. & Zimmermann, Ch. (1999a). II Verona-Medical Interview Classification System/Patient (VR-MICS/P). Presentazione dello strumento e studio di attendibilita. Epidemiologia e Psichiatria Sociale 8, 56–67.CrossRefGoogle Scholar
Del Piccolo, L., Saltini, A., Cellerino, P. & Zimmermann, Ch. (1999b). VR-MICS/P. Verona Medical Interview Classification System - Patient. Classification degli Interventi del Paziente durante I 'Intervista Medica. Manuale ad uso intemo del Dipartimento di Medicina e Sanità Pubblica. Servizio di Psicologia Medica. Universita di Verona.Google Scholar
Del Piccolo, L., Saltini, A., Zimmermann, Ch. & Dunn, G. (2000). Differences in verbal behaviours of patients with and without emotional distress during primary care consultations. Psychological Medicine 30, 629–643.CrossRefGoogle ScholarPubMed
del Vecchio Good, M.J., Good, B.J. & Cleary, P.D. (1987). Do patient attitudes influence physician recognition of psychosocial problems in primary care? Journal of Family Practice 25, 53–59.Google Scholar
Dohrenwend, B.S., Cook, D. & Dohrenwend, B.P. (1981). Measurement of social functioning in community populations. In What is a Case? The Problem of Definition in Psychiatric Community Surveys (ed. Wing, J.K., Bebbington, P. and Robins, L.N.), pp. 183–201. Grant Mclntyre: London.Google Scholar
Dohrenwend, B.S., Dohrenwend, B.P., Link, B. & Levav, I. (1983). Social functioning in psychiatric patients in the general population. Archives of General Psychiatry 40, 1174–1182.CrossRefGoogle ScholarPubMed
Dowrick, C. (1992) Improving mental health through primary care. British Journal of General Practitioners 42, 382–386.Google ScholarPubMed
Dowrick, C. (1994) Talking about depression, reducing the barriers between patients and their doctors. In Promotion of Mental Health (ed. Trend, D.R. and Reed, C.A.), pp 294–302. Avebury Press: Aldershot.Google Scholar
Dowrick, C. & Buchan, I. (1995). Twelve month outcome of depression in general practice, does detection or disclosure make a difference? British Medical Journal 311, 1274–6.CrossRefGoogle ScholarPubMed
Duffy, D.L., Hamerman, D. & Cohen, M.A. (1980) Communication skills of house officers, A study in a medical clinic. Annals of Internal Medicine 93, 354–360CrossRefGoogle Scholar
Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129–136.CrossRefGoogle Scholar
Engel, G.L. (1978). The psychosocial model and the education of health professionals. Annals of NY Academy of Sciences, 310, 169–181.CrossRefGoogle Scholar
Engel, G.L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535–544.Google ScholarPubMed
Feinstein, A.R. (1987). The intellectual crisis in clinical science: meddled models and muddled mettle. Perspectives in Biology and Medicine, 30, 215–230.CrossRefGoogle Scholar
Ford, S., Fallowfield, L. & Lewis, S. (1996). Doctor-patient interactions in oncology. Social Science and Medicine 42, 1511–19.Google Scholar
Freidson, E. (1970). Profession of Medicine. A Study in the Sociology of Applied Knowledge. Dodd Mead: New York.Google Scholar
Gala, C., Musicco, F., Durbano, F. & Cesana, B. (1995). Italian validation of the Multidimensional Scale of «Health Locus of Control». New Trends in Experimental and Clinical Psychiatry 11, 79–86.Google Scholar
Goldberg, d. (1972). The Detection of Psychiatric Illness by Questionnaire. Maudsley Monograph 21. Oxford University Press: London.Google Scholar
Goldberg, d. & Williams, P. (1988) The User's Guide to the General Health Questionnaire. NFER/NELSON: Windsor, Slough.Google Scholar
Goldberg, D., Privett, M., Ustun, B., Simon, G. & Linden, M. (1998). The effects of detection and treatment on the outcome of major depression in primary care, a naturalistic study in 15 cities. British Journal of General Practice 48, 1840–1844.Google ScholarPubMed
Good, M.J., Good, B.J. & Cleary, P.D. (1987) Do patient attitudes influence physician recognition of psychosocial problems in primary care? Journal of Family Practice 25, 53–59.Google ScholarPubMed
Gulbrandsen, P., Hjortdahl, P. & Fugelli, P. (1997). General practitioner's knowledge of their patients' psychological problems, multipractice questionnaire survey. British Medical Journal 314, 1014–8.CrossRefGoogle Scholar
Hale, W.D. & Cochran, C.D. (1987). The relationship between locus of control and self reported psychopathology. Journal of Social Psychology 127, 31–37.Google ScholarPubMed
Hirschfeld, R.M.A., Klerman, G., Gough, H.G., Barrett, J.Korchin, S., & Chodoff, P. (1977). A measure of interpersonal dependency. Journal of Personality Assessment 41, 610–618.Google Scholar
Hunter, N.L. & Locke, S.E. (1984). Health locus of control. A potential moderator variable for the relationship between life stress and psychopathology. Psychotherapy and Psychosomatics 41, 186–194.Google Scholar
Ingham, J.G. & Miller, P. (1976). The concept of prevalence applied to psychiatric disorders and symptoms. Psychological Medicine 6, 217–225.CrossRefGoogle ScholarPubMed
Ingham, J.G., Kreitman, N.B., McMiller, P., Sashidaran, P. & Surtess, p.G. (1986). Self-esteem, vulnerability and psychiatric disorder in the community. British Journal of Psychiatry 148, 375–385.CrossRefGoogle ScholarPubMed
Jacobson, A.M. (1995) Health-care-seeking behavior. Implications for the primary care physician. Psychosomatic Medicine 57, 48–49.CrossRefGoogle ScholarPubMed
Kaplan, S.H., Greenfield, S., Gandek, B., Rogers, W.H. & Ware, J.E. (1996). Characteristics of physicians with participatory decisionmaking styles. Annal of Internal Medicine 124, 497–504.CrossRefGoogle Scholar
Karlsson, H., Lehtinen, V. & Joukamaa, M. (1995). Psychiatric morbidity among frequent attender patients in primary care. General Hospital Psychiatry 17, 19–25.Google Scholar
Klinkam, M.S. (1997). Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. General Hospital Psychiatry 19, 98–111.Google Scholar
Levenstein, J.H., Brown, J.B., Weston, W.W., Stewart, M.A., McCracken, E.C. & McWhinney, I.R. (1989). Patient centred clinical interviewing. In Communicating with Medical Patients (ed. Stewart, M.A. and Roter, D.L.), pp. 81–103. Sage publications: Newbury Park, CA.Google Scholar
Levinson, W. & Roter, D. (1995). Physicians' psychosocial beliefs correlate with their patient communication skills. Journal of General Internal Medicine 10, 375–379.CrossRefGoogle ScholarPubMed
Loas, G. & Boyer, P. (1995). Relationship between anhedonia, affective dependency and autonomy in health subjects. Acta Psychiatrica Belgica 95, 152–158.Google ScholarPubMed
Loas, G., Verrier, A., Gayant, C. & Guelfi, J.D. (1998). Depression and dependency, distinct or overlapping constructs? Journal of Affective Disorders 47, 81–85.Google Scholar
Martin, F.J. & Bass, M.J. (1989). The impact of discussion of non-medical problems in the physician's office. Family Practice 6, 254–258.Google Scholar
Overholser, J.C. (1996). The dependent personality and interpersonal problems. Journal of Nervous and Mental Disorders 184, 8–16.CrossRefGoogle ScholarPubMed
Pendleton, D. & Hasler, J. (1983). Doctor-patient communication. A review. In Doctor-Patient Communication (ed. Pendleton, D. & Hasler, J.), p. 5. Academic Press: London.Google Scholar
Piccinelli, M. (1997). Test-retest reliability of the Social Problem Questionnaire in primary care in Italy. Social Psychiatry and Psychiatric Epidemiology 32, 57–62.CrossRefGoogle ScholarPubMed
Piccinelli, M., Bisoffi, G., Bon, M.G., Cunico, L. & Tansella, M. (1993). Validity and test-retest reliability of the italian version of the 12-item General Health Questionnaire in general practice. A comparison between three scoring methods. Comprehensive Psychiatry 34, 198–205.Google Scholar
Pincus, A.L. & Gurtman, M.B. (1995). The three faces of interpersonal dependency, Structural analyses of self-report dependency measures. Journal of Personality and Social Psychology 69, 744–758.CrossRefGoogle ScholarPubMed
Pini, S., Piccinelli, M. & Zimmermann-Tansella, Ch. (1995). Social problems as factors affecting medical consultation. A comparison between general practice attenders and community probands with emotional distress. Psychological Medicine 25, 33–41.Google Scholar
Robbins, J.M., Kirkmayer, L.J., Cathebras, P., Yaffe, M.J. & Dworkind, M. (1994) Physician characteristics and the recognition of depression and anxiety in primary care. Medical Care 32, 795–812.CrossRefGoogle ScholarPubMed
Robinson, J.W. & Roter, D.L. (1999). Psychosocial problem disclosure by primary care patients. Social Science and Medicine 48, 1353–1362.Google Scholar
Rolland, J.S. (1984). Toward a psychosocial typology of chronic and life-threatening illness. Family Systems and Medicine 2, 245–262.CrossRefGoogle Scholar
Saltini, A. & Del Piccolo, L. (2000). L'intervista medica in medicina generale. Recenti Progressi in Medicina 1, 38–42.Google Scholar
Saltini, A., Cappellari, D., Cellerino, P., Del Piccolo, L. & Zimmermann, Ch. (1998). Uno strumento per la valutazione dell'intervista medica nel contesto della medicina generale, il VR-MICS/D (Verona-Medical Interview Classification System/Doctor). Epidemiologia e Psichiatria Sociale 3, 210–223.CrossRefGoogle Scholar
Saltini, A., Del Piccolo, L., Cellerino, P. & Zimmermann, Ch. (1999). VR-MICS/D. Verona Medical Interview Classification System - Doctor. Classificazione degli Interventi del Medico durante l'intervista Medica. Manuale ad uso intemo del Dipartimento di Medicina e Sanità Pubblica. Servizio di Psicologia Medica, Università di Verona.Google Scholar
Schulberg, H.C., McClelland, M., Coulehan, J.L., Block, M. & Werner, G. (1986) Psychiatric decision making in family practice. Future research directions. General Hospital Psychiatry 8, 1–6.CrossRefGoogle ScholarPubMed
Schwenk, T.L. (1987) Caring about and caring for the psychosocial needs of patients. Journal of Family Practice 24, 461–463.Google ScholarPubMed
Simpson, M., Buckman, R., Stewart, M., Maguire, P., Lipkin, M., Novack, D. & Till, J. (1991) Doctor-patient communication, the Toronto consensus statement. British Medical Journal 303, 1385–1387.Google Scholar
Smith, R. (1996). La Storia del Paziente. Vn Approccio Integrato al-I'lntervista Medica. II Pensiero Scientifico Editore: Roma.Google Scholar
Smith, R.C. & Hoppe, R.B. (1991). The patient's story integrating the patient- and physician-centred approaches to interviewing. Annals of Internal Medicine 115, 470–475.CrossRefGoogle Scholar
Southgate, L.J. & Bass, M.J. (1983) Determination of worries and expectations of family practice patients. Journal of Family Practice 16, 339–344.Google Scholar
Tate, P. (1994). The Doctors Communication Handbook. Radcliffe Medical Press: Radcliffe.Google Scholar
Tuckett, D., Boulton, M., Olson, C., & Williams, A. (1985). Meeting Between Experts: an Approach to Sharing Ideas in Medical Consultations. Tavistock: London.Google Scholar
Van de Kar, A., Knottnerus, A., Meertens, R., Dubois, V. & Kok, G. (1992). Why do patients consult the general practitioner? Determinants of their decision. British Journal of General Practice 42, 313–316.Google ScholarPubMed
Wallston, B.S., Wallston, K.A., Kaplan, G.D. & Maides, S.A. (1976). Development and validation of the Health Locus of Control (HLC) Scale. Journal of Consulting and Clinical Psychology 44, 580–585.CrossRefGoogle ScholarPubMed
Wallston, B.S. & Wallston, K.A. (1978). Locus of Control and health, a review of the literature. Health Education Monographs 6, 107–117.CrossRefGoogle Scholar
Weich, S., Lewis, G., Donmall, R. & Mann, A. (1995). Somatic presentation of psychiatric morbidity in general practice. British Journal of General Practice 45, 143–147.Google ScholarPubMed
Weich, S., Glyn, L. & Mann, A. (1996). Effect of early experiences and personality on the reporting of psychosocial distress in general practice. A preliminary investigation. British Journal of Psychiatry 168, 116–120.CrossRefGoogle ScholarPubMed
Weyrauch, K.F., Rhodes, L., Psaty, B.M. & Grubb, D. (1995). The role of physicians' personal knowledge of the patient in clinical practice. Journal of Family Practice, 40, 3, 249–256.Google Scholar
Williams, S.J., Diehr, P., Drucker, W.L. & Richardson, W.C. (1979). Mental health services: utilization by low income enrollees in a prepaid group practice plan and in an independent practice plan. Medical Care, 17, 139–51.CrossRefGoogle Scholar
Zimmermann-Tansella, ch. & Siciliani, O. (1990). Social problems, social support and emotional distress in the community. In The Public Health Impact of Mental Illness (ed. Goldberg, D. and Tantam, D.), pp. 136–144. Hogrefe and Huber Publications: Toronto.Google Scholar
Zimmermann, Ch. & Tansella, M. (1996). Psychosocial factors and physical illness in primary care, promoting the biopsychosocial model in medical practice. Journal of Psychosomatic Research 40, 351–358.CrossRefGoogle ScholarPubMed
Zimmermann, Ch., Del Piccolo, L. & Saltini, A. (1999). Insegnare l'approccio biopsicosociale nella conduzione dell'intervista medica prima di insegnare a riconoscere i disturbi emotivi. Epidemiologia e Psichiatria Sociale 8, 71–78.Google Scholar