Psychiatric Morbidity in General Practice: Identification and Treatment

Abstract

In the past, reported prevalence rates of psychiatric disorders have varied enormously. However, there is growing evidence to suggest that once methods of recording and classification of psychiatric disorders can be standardised, closer agreement on psychiatric incidence and prevalence can be obtained, even among psychiatrists from different countries. However, cross-national studies of the psychiatric diagnostic habits of family physicians are lacking. In addition, the diversity of national health care systems means that the extent to which psychiatric disorders are encountered and recognised by family physicians varies considerably. A Czechoslovakian survey, for example, found that fewer than 20 per cent of psychiatric cases had been seen initially by district physicians (Polachek, 1972) whereas in the United Kingdom the general practitioner is the first medical contact for almost all patients who come to psychiatric clinics. From British studies of patients registered under the National Health Service, it appears that 60–70 per cent consult their doctor in any one year and that the proportion of patients who have not consulted for two years or longer is only about 10 per cent. These figures strongly reinforce the view that such a practitioner is well placed to monitor psychiatric disorders in the general population and to identify those serious enough to warrant treatment. Such assumptions cannot be made in health systems where services are based chiefly on private practice, since many patients will be unable or unwilling for financial reasons to seek medical aid.