Depression, anxiety, and insomnia are common symptoms evaluated in primary care practice that may be associated with substance use disorders or high‐risk substance use. Our objective was to examine the frequency of documentation of alcohol use as a component of the assessment of patients diagnosed with depression, anxiety, or insomnia and to examine the effect of patient gender on the rates of documentation of alcohol use. Records of 257 patients were reviewed; patients’ average age was 43; 79.8% were female; and 54% were smokers. Thirty‐six percent of patients had current alcohol use documented as a component of the assessment; women were half as likely as men to have their use documented. In a multivariate analysis, patient age (OR, 2.1; CI 1.2 to 3.5) and a history of substance abuse (OR, 2.5; CI, 1.4 to 4.9), not patient or physician gender, were associated with increased likelihood of documentation of alcohol use during the assessment of psychiatric symptoms.
RegiesDA, NarrowWE, RaeDS, ManderschudRW, LockeBZ and GoodwinFK. 1993. The de facto US mental and addictive disorders service system: Epidemiologie Catchment Area prospective 1‐year prevalence rates of disorders and services. Arch Gen Psychiatry, 50: 85–94.
2.
JencksSF. 1985. Recognition of mental distress and diagnosis of mental disorder in primary care. JAMA, 253: 1903–1907.
3.
VonKorffM, ShapiroS, BurkeJD, TeitelbaumM, SkinnerEA, GermanP, TurnerRW, KleinL and BurnsBJ. 1987. Anxiety and depression in a primary care clinic: Comparison of diagnostic interview schedule, general health questionnaire, and practitioner assessments. Arch Gen Psychiatry, 44: 152–156.
4.
FlemingM. Competencies for substance abuse training. Proceedings of Conference on Training About Alcohol and Substance Abuse for all Primary Care Physicians. pp.213–247. Phoenix, Arizona: Josiah Macy, Jr. Foundation.
5.
American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., Washington, DC: American Psychiatric Press.
6.
BirnbaumIM, TaylorTH and ParkerES. 1983. Alcohol and sober mood state in female social drinkers. Alcohol Clin Exp Res, 7: 362–368.
7.
SmailP, StockwellT, CanterS and HodgsonR. 1984. Alcohol dependence and phobic anxiety states. II. retrospective study. Br J Psychiatry, 144: 58–63.
8.
StockwellT, SmailP, HodgsonR and CanterS. 1984. Alcohol dependence and phobic anxiety states. II. A retrospective study. Br J Psychiatry, 144: 58–63.
9.
KalesA, SoldatesCR, BixlerEO and KalesJD. 1983. Rebound insomnia and rebound anxiety: A review. Pharmacology, 26(3): 121–137.
10.
ColemanRM, RoffwargHP and KennedySJJ. 1982. ET AL.: Sleep‐wake disorders based on a polysomnographic diagnosis: A national cooperative study. JAMA, 47: 997–1003.
11.
Depression Guideline Panel. Depression in Primary Care. 1993. Detection, Diagnosis and Treatment, Quick Reference Guide for Clinicians, Number 5Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93–0552
12.
WeissRD, MirinSM and GriftinML. 1992. Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers. Br J Addict, 87: 179–187.
13.
Depression Guideline Panel: Depression in Primary Care. 1993. Volume 1, Diagnosis and Detection, Clinical Practice Guideline, Number 543–47. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93–0551
14.
American Psychiatric Association. 1993. Practice guideline for major depressive disorder in adults. Am J Psychiatry Supplement, 150: 1–26.
15.
GrahamAV, ParanTV and JaénCR. 1992. Physician failure to record alcohol use history when prescribing benzodiazopines. J Substance Abuse, 4: 179–185.
16.
RoterD, LipkinM and KorsgaardA. 1991. Sex differences in patients’ and physicians’ communication during primary care medical visits. Med Care, 29: 1083–1093.
17.
Council on Ethical and Judicial Affairs. 1991. American Medical Association. Gender disparities in clinical decision making. JAMA, 266: 559–562.
18.
LevyS, DowlingP, MonroeA. Boult and McQuadeW. 1992. The effect of physician and patient gender on preventive medicine practices in patients older than fifty. Family Med, 24: 58–61.
19.
LurieM, SlaterJMcGoverP. 1993. Preventive care for women. Does the sex of the physician matter. N Engl J Med, 329: 478–482.
20.
SteingartRM, PackerMHammP. 1991. Sex differences in the management of coronary artery disease. N Engl J Med, 325: 226–230.
21.
AyanianJZ and EpsteinAM. 1991. Differences in the use of procedures between women and men hospitalized tor coronary heart disease. N Engl J Med, 325: 221–225.
22.
GerberPD, BarrettJ, ManheimerE, WhitingR and SmithR. 1989. Recognition of depression by internists in primary care. J Gen Intern Med, 4: 7–13.
23.
BorusJF, HowesMJ, DevinsNP, RosenbergR and LivingstonWW. 1988. Primary health care providers’ recognition and diagnosis of mental disorders in their patients. Gen Hosp Psychiatry, 10: 317–321.
24.
RedmanS, WebbGR, HennrikusDJ, GordonJJ and Sanson‐FisherRW. 1991. The effects of gender on diagnosis of psychological disturbance. J Behav Med, 14: 527–540.
25.
SchulbergHC and BurnsBJ. 1988. Mental disorders in primary care: Epidemiologic, diagnostic, and treatment research directions. Gen Hosp Psychiatry, 10: 79
26.
ClearyPD. 1987. “Gender differences in stress related outcomes”. In Gender and Stress, Edited by: BarnettRC, BienerL and BaruchGK. New York: Free Press.
27.
CooperstockR. 1976. Psychotropic drug use among women. CMAJ, 115: 760–763.
28.
AndersonJE. 1981. Prescribing of tranquilizers to women and men. CMAJ, 125: 1229–1232.
29.
LambertsH, WoodM, LambertsH, WoodM and Hofmans‐OakesI, eds. 1993. The International Classification of Primary Care in the European Community: Multi‐language Layer, New York: Oxford University Press.
30.
RostK, SmithGR, MatthewsDB and GuiseB. 1994. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med, 3: 333–337.
31.
FlemingM, RivoM and KahnR. 1995. “Tobacco, alcohol, and drug use in primary care: Prevalence treatment and costs”. In Training About Alcohol and Substance Abuse for Primary Care Physicians, Edited by: SiricaCoimbra. 275–290. New York: Josiah Macy, Jr., Foundation.
32.
RegierDA, FarmerMERaeDS. 1990. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA, 264: 2511–2518.
33.
BrittH, BhasaleA, MilesDA, MezaA, SayerG and AngelisM. 1996. The sex of the general practitioner: A comparison of characteristics, patients, and medical conditions managed. Med Care, 34: 403–415.
34.
BensingJM, Van den Brink‐MuinenA and De BakkerDH. 1993. Gender differences in practice style: A Dutch study of general practitioners. Med Care, 31: 219–229.
35.
Secretary of Health and Human Services. 1994. Eighth Special Report of the U.S. Congress on Alcohol and Health, Washington, DC: U.S. Department of Health and Human Services.
36.
McInnesE and PowellJ. 1994. Drug and alcohol referrals: Are elderly substance abuse diagnoses and referrals being missed?. BMJ, 308: 444–446.
37.
GrantBF, HarfordTC, ChouP, PickeringR, DawsonDA, StinsonFS and NobleJ. 1991. Epidemiologic Bulletin No. 27: Prevalence of DSM‐III‐R alcohol abuse and dependence: United States 1988. Alcohol Health Res World, 15(1): 91–96.
38.
KesslerRC, McGonagleKAZhaoS. 1994. Lifetime and 12‐month prevalence of DSM III‐R psychiatric disorders in the United States. Arch Gen Psychiatry, 51: 8–19.
39.
HallJA, PalmerRH, OravEJ, HargravesJL, WrightEA and LouisTA. 1990. Performance quality, gender, and professional role: A study of physicians and nonphysicians in 16 ambulatory care practices. Med Care, 28: 489–501.
40.
RobinsLN, HeizerJE, WeissmanMM, OrvaschelH, GruenbergE, BerkeJDJr. and RegierDA. 1984. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry, 41: 949–958.
41.
FordDE and KamerowDB. 1989. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA, 262: 1479–1484.
42.
OppenheimerE. 1991. Alcohol and drug misuse among women: An overview. Br J Psychiatry, 158(Suppl 10): 36–44.
43.
HesselbrockMN, MeyerRE and KeenerJJ. 1985. Psychopathology in hospitalized alcoholics. Arch Gen Psychiatry, 42: 1050–1055.
44.
GoldingJM, BurnhamMA, BenjaminB and WellsKB. 1993. Risk factors for secondary depression among Mexican Americans and non‐Hispanic whites. J Nervous Ment Dis, 181: 166–174.
45.
CypressB. 1977. Characteristics of visits to female and male physicians. The National Ambulatory Medical Care Survey. Vital Health Stat Ser, 13(49)
46.
KellyJM. 1980. Sex preference in patient selection of a family physician. J Family Practice, 11: 427–433.
47.
HohmannAA. 1989. Gender bias in psychotropic drug prescribing in primary care. Med Care, 27: 478–490.
48.
JohnsonPA, GoldmanL, OravEJ, ZhouL, GarciaT, PearsonSD and LeeTH. 1996. Gender differences in the management of acute chest pain: Support for the yentl syndrome. J Gen Intern Med, 11: 209–217.
49.
SiricaCM. 1994. Training About Alcohol and Substance Abuse for all Primary Care Physicians, 13–107. Phoenix, AZ: Josiah Macy, Jr., Foundation.
