General practitioners’ management of patients with psychological stress: audit results from Denmark

BACKGROUND: In western countries, psychological stress is among the most common causes of long-lasting sick leave and a frequent reason to consult the general practitioner (GP). This study aimed to investigate how GPs manage patients with psychological stress and how the management is associated with the patient’s sex, the GP’s assessment of causality, and coexisting mental disorders. METHODS: We conducted an audit of consecutive cases in Danish general practice. The GPs used electronic medical records to fill in a registration form for each 18–65-year-old patient with whom they had had at least one consultation regarding stress during the past 6 months. Only patients initially in the workforce were included. Age- and sex-adjusted binary regression was applied. RESULTS: Fifty-six GPs (61% women) identified 785 cases. The patients’ mean age was 44 years and 70% were women. The cause of stress was considered at least partially work-related in 69% of the cases and multifactorial in a third of cases. The management included sick leave (54%), counselling (47%), pharmaceutical treatment (37%), and referral to psychologist (38%). Compared to women, stress in men was less often considered work-related (RR: 0.84, CI95%: 0.77–0.92) and men were less often sick-listed (RR: 0.83 CI95%: 0.73–0.96) but were more often prescribed tranquilizers (RR: 1.72 CI95%: 1.08–2.74). CONCLUSIONS: GPs’ management of patients with stress usually involve elements of counselling, sick leave, referral to psychologist, and medication. Women and men with stress are perceived of and managed differently.