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Pearl S. German, ScD; Sam Shapiro; Elizabeth A. Skinner, MSW; Michael Von Korff, ScD; Lawrence E. Klein, MD; Raymond W. Turner, MD; Mark L. Teitelbaum, MD; Jack Burke, MD; Barbara J. Burns, PhD

JAMA. 1987;257(4):489-493.

Abstract
Evidence is accruing that older individuals receive little attention for mental health problems and that any attention that is given is most often within the primary care setting. A randomized clinical trial was carried out at a primary care clinic of The Johns Hopkins University, Baltimore, testing the ability of feedback of the results of a screening instrument (the General Health Questionnaire) to increase awareness in clinicians of the emotional and psychological problems of their patients. This report contrasts those aged 65 years and older with younger patients. Detection and management of mental morbidity were lower for older individuals, but the feedback intervention increased the likelihood of attention to these problems. This was not true for younger patients. Detection was significantly higher for older patients when screening data were made available, as was management, although the latter difference was not statistically significant. There was evidence as well that the intervention moved clinicians to greater congruence with their older patients in the perception that current mental health problems existed. These findings have important implications for primary care.

(JAMA 1987;257:489-493)

Author Affiliations
From the Health Services Research and Development Center, Department of Health Policy and Management (Dr German, Mr Shapiro, and Ms Skinner), and the Department of Mental Hygiene (Dr Von Korff), School of Hygiene and Public Health, and the Division of Internal Medicine, Department of Medicine (Drs Klein and Turner), and the Department of Psychiatry (Dr Teitelbaum), School of Medicine, The Johns Hopkins University, Baltimore; and the Division of Clinical Research (Dr Burke) and the Epidemiology and Psychi-; atric Pathology Branch, Division of Biometry and Applied Sciences (Dr Burns), National Institute of Mental Health, Rockville, Md. Dr Von Korff is now with the Group Health Cooperative of Puget Sound, Seattle, and Dr Turner is now with HealthAmerica, Inc, Baltimore.

Footnotes
Reprint requests to Health Services Research and Development Center, Department of Health Policy and Management, School of Hygiene and Public Health, The Johns Hopkins University, 624 N Broadway, Baltimore, MD 21205 (Dr German).

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