Use of the General Health Questionnaire as a screening tool for geriatric patients in Calabar, Nigeria.

BACKGROUND: Old age is inevitably associated with general biological and physical decline.Mental health issues are among the most prevalent health problems of the elderly and constitute an important source of distress for patients and caregivers. Primary care providers frequently fail to diagnose these problems, and, even when they do, management may not be optimal. This study aimed to determine the proportion of geriatric mental health morbidity detected by Family Physicians and compare this with General Health Questionnaire detection in the recognition ofmorbidity in this cohort. METHOD: This was a cross-sectional descriptive survey involving 107 elderly respondents, conveniently recruited for the study from the Family Medicine Geriatric Clinic of the University of Calabar Teaching Hospital, Calabar. Respondents were grouped into 'cases' and 'non-cases' using a cut-offscore of'3' with the General Health Questionnaire as the main comparative detection instrument. Family Physicians' abilities to identify mental health morbidity were then compared with the General Health Questionnaire ratings. Socio-demographic correlates and identification rates were determined by statistical tests of associations. RESULTS: The General Health Questionnaire identified 48.6% 'cases' while the Family Physicians identified 9.4% among the attendees. Statistically significant differences in socio-demographic characteristics of respondents were found for marital status (chi2 = 21.84; p< 0.009), level of education (chi2 = 42.58; p<0.005) and sex chi2 = (6.98; p<0.008). CONCLUSION: This study concludes that using the General Health Questionnaire and paying attention to geriatrics' socio-demographic parameters can improve the detection of mental health morbidities in the elderlyby Family Physicians.

Recognition of mental health problems by primary care physicians in a tertiary care hospital in Nigeria.

AIMS AND OBJECTIVES: This study sought to determine the difference in detection of attendees with mental health problems visiting the General Out-patient clinic of a tertiary institution; the General Health Questionnaires (GHQ-12) were compared with those identified by the physicians. PATIENTS AND METHODS: Three hundred and twenty two (322) subjects aged 18 years and above, attending the clinic for the first time, were recruited for the study by a systematic random sampling method. Using a cut off score of '3' on the 12-item General Health Questionnaire (GHQ-12), 'Cases' and 'Non-cases' generated were compared with those identified by the doctors. Identification rates for both groups were calculated and the coefficients determined using a two-by-two contingency table. RESULTS: The GHQ-12 identified 46.6% 'cases' while the General Out-patient Clinic (GOPC) doctors identified 6.8% with a diagnostic sensitivity of 8% and a specificity of 94% CONCLUSION: Despite the high proportion of mental health problems in the GOPC of the hospital, the detection rate by the clinic doctors was low. There is a need for the use of an easy tool like the GHQ-12 for screening and identification of attendees with mental health problems especially in a busy clinic setting.

Patient characteristics that may predict the likelihood of the presence of mental health problems in patients attending the general outpatient clinic of a tertiary hospital in South-South Nigeria.

Background A considerable number of patients seen in general outpatient clinics (GOPC) are known to suffer from psychiatric rather than physical disorders. Studies have shown that doctors working in these clinics have difficulty in making accurate ratings of mental health problems in their patients and have poor knowledge of psychiatric diagnosis. Accurate recognition of psychiatric symptoms in a patient is essential for specific diagnosis and successful management. There is a need for the use of an easy tool such as the12-item General Health Questionnaire (GHQ-12) for screening and identification of psychopathologies especially in a busy clinic setting like the GOPC. Aside from psychometric screening tools, patients' sociodemographic characteristics such as gender, age, marital status, occupation, education etc. have been found to be of value in predicting those at risk.Objectives This study seeks to correlate GHQ 'caseness' with sociodemographic factors and to compare physician diagnosis with GHQ diagnosis.Subjects and method Three-hundred and twenty-two respondents were recruited for the study by a systematic random sampling method. Using a cut off score of three on both the English and Efik translation versions of the GHQ-12, 'cases' and 'non-cases' generated were compared with the same classification as identified by the GOPC doctors. Identification rates for both groups were calculated and the coefficients determined using a two-by-two contingency table. Sociodemographic correlates were determined by statistical comparison of the classifications in both groups.Results Statistically significant differences in sociodemographic characteristics of respondents were found for age (χ(2)=48.97; P <0.05) and education (χ(2)=45.64; P=0.05) using their GHQ-12 scores, and for occupation (χ(2)=37.90; P <0.05) among those seen by the GOPC doctors. A further comparison of identified 'cases' and 'non-cases' by doctors again revealed significant difference for age (χ(2)=7.151; P <0.05). Sex as a sociodemographic characteristic showed no statistically significant difference though a greater percentage of females (57.3%) were observed as 'high scorers' as compared to their male counterparts (42.7%). The GHQ-12 identified 46.6% 'cases' while the GOPC doctors identified 6.8% among the attendees with a diagnostic sensitivity of 8% and a specificity of 94%, respectively.Conclusion Belonging to the 18-39 years age group, being employed and having less than 12 years of education were the patients' characteristics that suggested the likelihood of the presence of mental health problems.This study also revealed that despite the high proportion of psychiatric morbidity (46.6%) in the GOPC of the University of Calabar Teaching Hospital (UCTH) rate of detection by the clinic doctors was low (6.8%).It is recommended that primary care doctors should be alerted to the possibility that clinically significant psychiatric morbidity may be present in GOPC attendees. The correlation between patients' sociodemographic parameters and presence of mental health problems could be informative and should be given adequate attention during consultation.