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Table 4 Summary of articles included, details of the included articles including country, participants, study design and findings

From: Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

Author/s, Date
(In order of appearance)
Country, Setting Participants
(type and number)
Study design Findings
Brown & Cooper 1987 [30] UK, general hospital 1,140 inpatient referrals Retrospective review of referrals in 1973, 1976, 1979 Dedicated CLP service increases referrals.
McCartney et al. 1989 [31] US, university hospital 11,713 gynaecologic oncology and other cancer patients Retrospective review of referrals, before and after introduction of gynaecologic oncology liaison program Introduction of CLP program increases referrals
Thompson et al. 1990 [32] US, Colorado 200 non-psychiatrist doctors (35 % response rate) 16 item survey Most common reasons for not referring: Other mental health practitioners do just as well, lack of communication by psychiatrist, stigma, accessibility
Mezey & Kellett 1971 [33] UK, London 106 consultants from 6 hospitals (83 % response rate) 10 item survey Most common reasons for not referring: Patient’s preference, stigma, accessibility, poor rapport with psychiatrist. Surgery, Obstetrics and Gynaecology subspecialty associated with less referrals
Diefenbacher 2001 [35] Germany, Berlin, Rudolf Virchow Hospital 208 inpatient referrals Observational study of referral patterns over 1 year following introduction of CLP Increase in referrals from medical and surgical wards. Decrease in urgent referrals, suggesting increased tolerance towards psychiatric conditions.
Camus et al. 2003 [34] Switzerland, university hospital 176 medical inpatients Prospective cohort study on collaborative CLP screening Referral rates increase from 4 to 32 %.
Jo et al. 2011 [36] Korea, Seoul tertiary general hospitals 310 patients with suicide attempts Questionnaire on patients No significant difference in referral rate between history of suicide attempts and non-suicide attempters.
Pritchard 1972 [37] UK, London general hospital 252 patients Retrospective chart review of patients with psychiatric diagnosis Patients with suicidal attempts have highest referral rates. Young age, functional psychosis associated with increased referral. Organic psychosis and previous psychiatric contact associated with decreased referral.
Caplan et al. 2008 [38] US N/A Opinion piece Work pressure suggested with increased CLP referrals
Wood & Bisson 2004 [39] UK, maxillofacial surgery unit 58 patients with cancers of head and neck Subjective reporting of experience with mental health nurse liaison Increased referrals suggested with use of mental health nurse liaison.
Cohen-Cole et al. 1982 [40] US, North Carolina Memorial Hospital 407 hospital doctors (34 % response rate) 37 item questionnaire Physicians in internal medicine and family medicine tend to recognise patients with more psychological issues.
Most hospital doctors are comfortable with managing psychiatric illness.
Lin et al. 2011 [52] Taiwan, general hospital 111 obstetric and gynaecologic patients Retrospective chart review Low referral rates from obstetric and gynaecologic department.
Ni Mhaolain et al. 2008 [53] Ireland, general hospital 96 surgical patients Prospective evaluation of anxiety and depression in surgical patients High prevalence of depression and anxiety in surgical patients.
Balestrieri et al. 2002 [54] Italy, general hospital 1039 general inpatients Cross sectional investigation of prevalence of depression among hospital patients Identification of depression by hospital doctors in one third of all cases.
Fauman 1983 [55] US, private urban hospital 265 hospital doctors (41.9 % response rate) 66 item questionnaire Internists are more willing to refer suicidal attempts than surgeons. Internists are more willing to ask for consultations than surgeons for all other mental health conditions.
Hamdieh et al. 2015 [41] Iran, Tehran, general hospital 300 non-psychiatric doctors (64.3 % response rate) 8 item questionnaire Hospital doctors were more comfortable requesting for psychiatric consultations than managing psychiatric conditions themselves.
Jourdan & Glickman 1991 [57] US, general hospital 380 psychiatric referrals Retrospective chart review High referral rates for determination of competency. Fear of medico-legal consequences and referrer’s anxiety suggested as reasons for referral rates.
Cepoiu et al. 2008 [42] N/A 36 articles (comprising of 50935 inpatients) Meta-analysis of recognition of depression in inpatients by non-psychiatric doctors Sensitivity was found to be 36.4 % and specificity was 83.7 %
Clarke et al. 1995 [43] Australia, Melbourne, Monash Medical Centre 987 medical and surgical patients Prospective patient review, comparing diagnosis of depression made by psychiatrists and non-psychiatrists Diagnostic concordance of depression 74 %, 41 % false positive rate and 15 % false negative rate.
Dilts et al. 2003 [44] UK, York Hospital 346 medical inpatient consultations Retrospective review comparing initial impression of primary medical providers to final psychiatric diagnosis Initial diagnosis of cognitive disorders and substance use disorder is likely to be correct. Initial diagnosis of depression is wrong in half the cases.
Judd et al. 1997 [45] Australia, Melbourne 392 HIV/AIDS patients referred for CLP Retrospective chart review Diagnostic concordance of depression was 79 %, 20 % false positive rate and 23 % false negative rate
Ryan et al. 1995 [46] UK, Castle Hill Hospital 50 geriatric inpatients Prospective cohort study examining agreement between psychiatrist and geriatricians on depression and dementia Some evidence suggesting lower recognition of depression by geriatricians.
Yamada et al. 2012 [47] Japan, Tokyo Metropolitan Geriatric Hospital 172 geriatric inpatients Prospective diagnostic review of CLP consultations Almost half of patients with depression diagnosed by referrers were found to be delirium.
Boland et al. 1996 [48] US, teaching hospital 4396 inpatients referred for consultations Retrospective chart review 40 % of patients initially identified by referrer to be depressed were found not to be depressed by psychiatry consultants
Canuto et al. 2015 [49] Switzerland, University hospital of Geneva 148 inpatients over age of 60 Prospective cohort study 40 % of patients initially referred for depression were diagnosed with depression by CLP.
Smith et al. 1995 [50] Australia, Melbourne, Monash Medical Centre 2347 inpatient referrals Retrospective chart review 56 % of patients suspected by psychiatrist for substance use disorder were missed by referrers.
Su et al. 2011 [51] Taiwan, region general hospital 1007 inpatient referrals Retrospective chart review Only 41.5 % of initial physician’s impression matches with psychiatrist’s final impression
De-Nour 1979 [56] Israel 77 hospital doctors Survey Surgeons prefer consultation service, Physicians prefer liaison service.
Fenichel & Murphy 1985 [58] US, Hospital of the University of Pennsylviania emergency department 12095 patients presenting to emergency department Retrospective chart review Patient with psychiatric history were associated with psychiatric referral
Marcus et al. 1987 [59] US, 327 general hospitals 37221 patients with diabetes, 19484 patients with hip fractures, 25116 patients with COPD, 11770 patients with CABG Retrospective chart review Age negatively correlated to psychiatric consultation. Patients in urban settings are more likely to receive psychiatric consultation
Popkin et al. 1984 [60] US 111 geriatric inpatients Retrospective chart review Compared to younger population, geriatric population was less often referred
Handrinos et al. 1998 [62] Australia, Dandenong hospital 712 inpatient referrals Retrospective chart review Personality disorder predicts earlier referral. Depression predicts delayed referral.
Craig 1982 [63] US, university hospital (not named) 362 inpatient referrals Retrospective chart review White patients are more likely to be referred. Once referred, there is no difference in care to white or non-white population.
Collins et al. 1992 [64] US, San Diego Medical Centre 476 patients receiving psychiatric consultations compared with 14620 without psychiatric consultations Retrospective chart review Low referral rate for Hispanic patients.
Klein et al. 1996 [65] US, Montefiore Medical Centre 48 inpatients Survey 81 % agreeable to psychiatric consultation if their primary care doctor felt it was indicted