Title:
Detection of patient psychological distress and longitudinal patient-doctor relationships: a cross-sectional study.

Abstract:
Psychological distress in patients who attend their GP is thought to be under-recognised. However, it is likely that both disclosure and detection are influenced by how well the patient and doctor know each another.
To examine whether patient-doctor  depth of relationship is associated with identification of psychological distress.
Cross-sectional study in general practices in and around Bristol, England.
Patients (aged ≥16 years) were asked to complete a questionnaire  and consent to their electronic medical records being reviewed. Study GPs independently assessed patient psychological distress. Multivariable logistic regression was used to look for associations between patient-doctor depth of relationship and GP detection of patient psychological  distress (defined according to the 12-item General Health Questionnaire, GHQ-12).
There were 643 eligible appointments with 31 GPs. In total, 541 (84.1%) patients returned questionnaires and 490 (76.2%) consented to their records being reviewed. Patient-doctor  depth of relationship was not associated with GP detection of mild to severe patient psychological distress (adjusted odds ratio [OR] 0.94, 95% CI = 0.87 to 1.02) but, in secondary analyses, it was associated with the identification of moderate to severe distress (adjusted OR 1.13, 95% CI  = 1.02 to 1.26). GPs reported more patient psychological distress in patients who reported a greater depth of relationship but this did not relate to patients' GHQ-12 scores.
Evidence to support an association between patient-doctor depth of relationship  and improved GP detection of patients with psychological distress was weak, except in those patients who GPs thought were more distressed. GPs may overestimate emotional distress in patients who report deeper patient-doctor relationships.