Article2000

Prevalence of Anxiety, Depression, and Substance Use Disorders in an Urban General Medicine Practice

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Mental Health Treatment and Access Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Migration, Health and Trauma

Abstract

BACKGROUND: Most research on the prevalence of mental disorders in primary care has been conducted in practices that serve middle- and upper-income patients. OBJECTIVE: To determine the prevalence of major mental disorders in a primary care practice that serves a predominantly low-income immigrant patient population. DESIGN: Cross-sectional survey; criterion standard. SETTING: Urban general medicine practice. PARTICIPANTS: Systematic sample of consecutive adult patients with scheduled appointments. Of 1266 approached eligible patients, 1007 (80%) participated. MAIN OUTCOME MEASURES: PRIME-MD Patient Health Questionnaire major depression, generalized anxiety disorder, panic disorder, alcohol use disorder, and suicidal ideation; drug use disorder; functional status; work loss; family distress; and mental health treatment. RESULTS: Major depression (18. 9%), generalized anxiety (14.8%), panic (8.3%), and substance use (7. 9%) disorders and suicidal ideation (7.1%) were highly prevalent. Many patients had more than 1 disorder (range, 36.3% [substance use disorder] to 76.9% [panic disorder]). In multivariate analyses, each disorder was significantly associated with an increase in impairment after controlling for demographic characteristics, perceived health, and the other disorders. A minority of patients with each disorder (range, 22.5% [substance use disorder] to 46.4% [panic disorder]) reported receiving mental health treatment in the last month. CONCLUSIONS: Clinically significant depression, anxiety, substance use, and suicidal ideation are quite common in this practice and associated with significant functional impairment. Primary care practices that serve poor urban immigrant populations have a critical need to provide access to mental health services. Arch Fam Med. 2000;9:876-883

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References

1994Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States 1999Validation and Utility of a Self-report Version of PRIME-MD The PHQ Primary Care Study 1994Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study 1991Psychiatric disorders in America: the epidemiologic catchment area study 1976Assessment of Social Adjustment by Patient Self-Report 1992Socioeconomic Status and Psychiatric Disorders: The Causation-Selection Issue 1994DSM-III-R Generalized Anxiety Disorder in the National Comorbidity Survey 1995Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care

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