An investigation in primary care of the relationship between consultation behaviour, increased vaginal bleeding and mental disorder.

Studies have shown an association between consultation for increased vaginal bleeding and the presence of psychological disturbance. However, many of the studies have failed to control the known link between psychological distress and propensity to consult in general. The aim of this case-control study was to determine whether psychological distress in women consulting with increased vaginal bleeding is associated with the illness or with the propensity to consult. Women consulting as cases of 'increased vaginal bleeding' were compared with three sets of control women: two sets of consulting controls ('acute respiratory tract infection' or a physical 'other illness') and one set of community controls. Predictor measures were consultations and prescriptions in the previous 5 years. There was no difference in overall consultation rates (P = 0.19), proportion consulting for a mental disorder (P = 0.39), frequency of consultation for a mental disorder (P = 0.46) or having a prescribed hypnotic or anxiolytic (P = 0.29) between the three consulting groups. However, the consulting groups had higher rates of consulting both overall and specifically for a mental disorder than the community controls. The association between increased vaginal bleeding and mental disorder or use of psychotropic medication appeared to be explained by consultation behaviour.