Clinical Review

ABC of mental health: Common mental health problems in primary care

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7094.1609 (Published 31 May 1997) Cite this as: BMJ 1997;314:1609
  1. T K J Craig,
  2. A P Boardman

    The size of the problem

    Psychiatric symptoms are common in the general population: worry, tiredness, and sleepless nights affect more than half of adults at some time, while as many as one person in seven experiences some form of diagnosable neurotic disorder.

    These problems are not confined to Western countries. The World Health Organisation's study of mental disorder in general health care screened over 25 000 people in 14 countries worldwide and assessed 5500 in detail. A quarter had well defined disorders, and a further 9% had subthreshold conditions. The most common disorders were depression (10%), generalised anxiety disorder (8%), and harmful use of alcohol (3%).

    Anxiety and depression, often occurring together, are the most prevalent mental disorders in the general population

    Mental health problems in primary care

    • Emotional symptoms are common but do not necessarily mean that the sufferer has a mental disorder

    • Many mood disorders are short lived responses to stresses in peoples' lives such as bereavement

    • About 30% of people with no mental disorder suffer from fatigue, and 12% suffer from depressed mood

    • Anxiety and depression often occur together

    • Mental disorder comprises about 25% of general practice consultations–In Britain up to 80% of referrals to specialist psychiatric services come from primary care

    Bereavement

    Death of a loved one is a distressing episode in normal human experience. Expression of distress varies greatly between individual people and cultures, but grieving does not constitute mental disorder. The doctor's most appropriate response is compassion and reassurance rather than drug treatment. Night sedation for a few days may be helpful, but oversedation should be avoided. Antidepressants should be reserved for those patients who develop a depressive episode

    The 1993 world development report of the World Bank estimated that mental health problems produce 8% of the global burden of disease, a toll greater than that exacted by tuberculosis, cancer, or heart disease. Much of the …

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