Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP)
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Previous epidemiological studies have revealed a high prevalence of mental disorders among primary care (PC) patients. However, most studies have methodological limitations (e.g. absence of structured clinical interviews, two-phase designs) that affect the generalizability of their results. The main objective of the present study was to estimate the lifetime and 12-month prevalence of mental disorders in the PC of Catalonia (Spain), using structured clinical interviews and a one-phase design.
One-phase cross-sectional survey. A representative probability sample without replacement of individuals aged 18 years or older attending PC for a medical visit were interviewed between October 2005 and March 2006. The interviews included SCID-I for depressive and anxiety disorders and the MINI interview for other mental disorders. A total of 3,815 patients from 77 PC centres were included in the statistical analyses.
45.1% of respondents reported at least one lifetime mental disorder and 30.2% reported at least one mental disorder in the previous 12 months. The most common mental disorders were major depression (9.6%), panic disorder (7.0%), specific phobia (6.6%), and generalized anxiety disorder (3.8%). There was a high comorbidity between mood and anxiety disorders, as well as between mental disorders and some chronic physical conditions.
There is a high prevalence and comorbidity of mental disorders in the PC of Catalonia. Public health policies should reinforce the role of family physicians in the detection and treatment of persons with mental disorders.
KeywordsPrimary care Epidemiology Mental disorders Depressive disorders Comorbidity
We are indebted to the family physicians and patients who participated in this study. We are also very grateful to Ms. Cristina Molina, from the “Departament de Salut-Generalitat de Catalunya”, who conceived the DASMAP study. Support: Study funded by the “Direcció General de Planificació i Avaluació Sanitària-Departament de Salut-Generalitat de Catalunya” (Barcelona, Spain). AF and JVL are grateful to the “Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III” (Red RD06/0018/0017) for a predoctoral and a postdoctoral contract, respectively.
Conflict of interest statement
- 1.Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (2006) Measuring the global burden of disease and risk factors, 1990–2001. In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (eds) Global burden of disease and risk factors. Oxford University Press, New York, pp 1–13CrossRefGoogle Scholar
- 5.Baca-Baldomero E, Saiz J, Agüera LF, Caballero L, Fernández A, Ramos JA, Gil A, Madrigal M, Porras A (1999) Prevalence of psychiatric disorders in primary care using the PRIME-MD questionnaire. Aten Primaria 31:275–279Google Scholar
- 9.World Health Organization (2001) The world health report 2001—Mental health: new understanding, new hope. WHO, GenevaGoogle Scholar
- 13.First MB, Spitzer RL, Gibbon M, Williams JB (1996) Structured Clinical Interview for Axis I DSM–IV disorders, Research Version (SCID-RV). American Psychiatric Press, Inc, WashingtonGoogle Scholar
- 14.Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl. 20):22–33PubMedGoogle Scholar
- 15.Ferrando L, Franco AL, Soto M, Bobes J, Soto O, Franco L, Gubert J (1998) MINI international neuropsychiatric interview. Spanish version 5.0.0. DSM-IV. Instituto IAP, MadridGoogle Scholar
- 16.American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
- 17.World Health Organization (2002) Innovative care for chronic conditions. WHO, GenevaGoogle Scholar
- 20.National Center for Health Statistics (1994) Evaluation of National Health Interview Survey diagnostic reporting. Vital Health Stat Series 2. Data evaluation and methods research 120:1–116Google Scholar
- 23.Üstun TB, Sartorius N (1995) Mental illness in general health care. An international study. Wiley, Midsomer NortonGoogle Scholar
- 26.Norton J, De Roquefeuil G, Boulenger JP, Ritchie K, Mann A, Tylee A (2007) Use of the PRIME-MD Patient Health Questionnaire for estimating the prevalence of psychiatric disorders in French primary care: comparison with family practitioner estimates and relationship to psychotropic medication use. Gen Hosp Psychiatry 29:285–293CrossRefPubMedGoogle Scholar
- 30.Merikangas KR, Angst J, Eaton W, Canino G, Rubio-Stipec M, Wacker H, Wittchen HU, Andrade L, Essau C, Whitaker A, Kraemer H, Robins LN, Kupfer DJ (1996) Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. Br J Psychiatry 168:s58–s67Google Scholar
- 36.Torrens M, Serrano D, Astals M, Pérez-Domínguez G, Martín-Santos R (2004) Diagnosing comorbid psychiatric disorders in substance abusers: validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV. Am J Psychiatry 161:231–237CrossRefGoogle Scholar
- 37.World Health Organization (2008) Integrating mental health into primary care. A global perspective. WHO and WONCA editors, Singapore, pp 1–224. http://www.who.int/mental_health/policy/Mental%20health%20+%20primary%20care-%20final%20low-res%20120109.pdf
- 38.Koivumaa-Honkanen H, Tuovinen TK, Honkalampi K, Antikainen R, Hintikka J, Haatainen K, Viinamäki H (2008) Mental health and well-being in a 6-year follow-up of patients with depression: assessments of patients and clinicians. Soc Psychiatry Psychiatr Epidemiol 43(9):688–696CrossRefPubMedGoogle Scholar