Complexity of GPs' explanations about mental health problems: development, reliability, and validity of a measure.

BACKGROUND

How GPs understand mental health problems determines their treatment choices; however, measures describing GPs' thinking about such problems are not currently available.

AIM

To develop a measure of the complexity of GP explanations of common mental health problems and to pilot its reliability and validity.

DESIGN OF STUDY

A qualitative development of the measure, followed by inter-rater reliability and validation pilot studies.

SETTING

General practices in North London.

METHOD

Vignettes of simulated consultations with patients with mental health problems were videotaped, and an anchored measure of complexity of psychosocial explanation in response to these vignettes was developed. Six GPs, four psychologists, and two lay people viewed the vignettes. Their responses were rated for complexity, both using the anchored measure and independently by two experts in primary care mental health. In a second reliability and revalidation study, responses of 50 GPs to two vignettes were rated for complexity. The GPs also completed a questionnaire to determine their interest and training in mental health, and they completed the Depression Attitudes Questionnaire.

RESULTS

Inter-rater reliability of the measure of complexity of explanation in both pilot studies was satisfactory (intraclass correlation coefficient = 0.78 and 0.72). The measure correlated with expert opinion as to what constitutes a complex explanation, and the responses of psychologists, GPs, and lay people differed in measured complexity. GPs with higher complexity scores had greater interest, more training in mental health, and more positive attitudes to depression.

CONCLUSION

Results suggest that the complexity of GPs' psychosocial explanations about common mental health problems can be reliably and validly assessed by this new standardised measure.