Summary: A self-administered questionary (the General Health Questionnaire) aimed at detecting current psychiatric disturbance was given to 553 consecutive attenders to a general practitioner's surgery. A sample of 200 of these patients was given an independent assessment of their mental state by a psychiatrist using a standardized psychiatric interview. Over 90% of the patients were correctly classified as "well" or "ill" by the questionary, and the correlation between questionary score and the clinical assessment of severity of disturbance was found to be +0-80.The "conspicuous psychiatric morbidity" of a suburban general practice assessed by a general practitioner who was himself a psychiatrist and validated against independent psychiatric assessment was found to be 20%. "Hidden psychiatric morbidity" was found to account for one-third of all disturbed patients. These patients were similar to patients with "conspicuous illnesses" in terms both of degree of disturbance and the course of their illnesses at six-month follow-up, but were distinguished by their attitude to their illness and by usually presenting a physical symptom to the general practitioner.When 87 patients who had been assessed as psychiatric cases at the index consultation were called back for follow-up six months later, two-thirds of them were functioning in the normal range. Frequency of attendance at the surgery in the six months following index consultation was found to have only a modest relationship to severity of psychiatric disturbance.It is argued that minor affective illnesses and physical complaints often accompany each other and usually have a good prognosis.

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Chronic illness behavior is defined by frequent visits to physicians, multiple somatic complaints, and disability disproportionate to physical findings. The prevalence of chronic illness behavior in people with irritable bowel syndrome and peptic ulcer was studied in a telephone survey of 832 people from metropolitan Cincinnati. People with irritable bowel syndrome (8% of the sample) were more likely than people with peptic ulcer (10% of the sample), and also more likely than the general population, to have multiple somatic complaints, to view their colds and flus as more serious than those of other people, and to consult a physician for minor illnesses. People with peptic ulcer were not different from the rest of the population in these regards. Chronic illness behavior appears to be learned; people who recalled being given gifts or special foods when they had a cold or flu as a child were more likely to exhibit chronic illness behavior and also more likely to have irritable bowel syndrome. These results suggest that social learning may contribute to the etiology of irritable bowel syndrome but not peptic ulcer.