The Study of Episodes of Psychiatry Morbidity

It is well known that general practitioners (GPs) in Great Britain come into contact with, and are responsible for treating, the majority of patients with psychiatric disorders. It is not surprising, therefore, that one should look to records provided by GPs for important information about consultations and episodes of a wide variety of psychological problems. In particular, GPs are in a position to provide information on the natural history of these problems, on their patterns of incidence and recurrence, and on patterns of referral to other services. This information is rarely, if ever, available from other sources but the uncritical use of data provided by GPs, however, might be potentially misleading.

Unlike a psychiatrist, a GP cannot assume that a patient is consulting him because of psychological problems. Whether or not a psychiatric or psychological problem is detected is, of course, dependent on the state of the patient and what the patient is willing to reveal about this state. It is also dependent on the GP’s background and beliefs as well as on the outcome of previous contacts that the patient has had with the GP. There is also the possibility that many people who suffer from various forms of psychological distress would never seek help from a GP. Those who do will have different ‘thresholds’; many seeking help for relatively minor problems such as tension headaches or sleep loss, while others with psychotic symptoms such as paranoia or with dependencies on alcohol or drugs might refuse to acknowledge that they need help.

Clearly, it is vital that the natural history of psychiatric disorders as seen in general practice be studied in depth. Small-scale, intensive, longitudinal studies are essential but, however detailed, they run the risk of being unrepresentative. Increasing their size and scope, however, would be a difficult and costly undertaking. Large-scale morbidity studies, on the other hand, are comprehensive but the data obtained are, by necessity, relatively rather crude. The GPs taking part in the three UK National Morbidity Surveys, for example, may not be representative of GPs in Britain as a whole; their diagnostic and case-finding criteria differ widely and have not been validated, and, when episodes rather than consultations are being recorded, there appears to be no clear-cut definition of what constitutes an episode of psychiatric disorder. Despite these criticisms, however, these morbidity surveys should provide some useful information, but much more work needs to be done to attempt to provide effective and valid ways of analysing and presenting the data.

It is the purpose of this chapter to review some of the problems encountered in these National Morbidity Surveys, with particular reference to the analysis of data provided by the longitudinal file of the Second Survey and suggest some possibilities for solving them.