Assessing the need for psychiatric care. A review of the validity of epidemiologic surveys.

Abstract

This paper reviews the methodology employed in assessing the extent and characteristics of persons needing psychiatric care. Surveys of the need for physicians' care for any type of disorder (as well as psychiatric) are characterized by problems associated with: a) Diagnostic process b) Social factors in attending physicians c) The natural history of the disorder d) Definitions of impairment, disability and handicap e) Clinical insignificance of some statistically significant factors. Case-finding in psychiatry has additional problems associated with the use of symptom questionnaires; the criterion of work limitation; and the question of past versus present disability. Determination of the type of psychiatrists' care required is also of paramount importance. One should not equate symptoms with illness; nor symptoms with a need for psychiatrists' care. Community surveys have not yet been able to provide valid estimates of the nature or extent of psychiatrists' care required.