Prevalence

There is a vast body of research regarding the prevalence of behavioral health, including the frequency that mental health and substance use problems appear in primary care settings.

• “The current prevalence estimate is that about 20% of the U.S. population is affected by mental disorders during a given year. In general, 19% adults have a mental disorder alone in one year; 3% have both mental and addictive disorders; and 6% have addictive disorders alone. A subpopulation of 5.4% of adults is considered to have a serious “mental illness.”
  • Mental Health Report of the US Surgeon General, 1999.
• A comparison of 2,541 primary care and psychiatric specialty care clients at 14 treatment centers found that they had identical levels of moderately severe depression and identical distributions of depressive severity scores. Both primary care and specialty care participants showed considerable suicide risk and evidenced little difference in depressive symptoms or concurrent psychiatric disorders. Half the participants in each setting had an anxiety disorder (48.6% primary care vs 51.6% specialty care), with social phobia being the most common (25.3% primary care vs 32.1% specialty care).
  • Bradley Gaynes et al., “Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis”, Annals of Family Medicine, 2007, 5.
• Lifetime prevalence estimates are 28.8% for anxiety disorders, 20.8% for mood disorders, 24.8% for impulse-control disorders; 14.6% for substance use disorders; and 46.4% for any disorder.
  • Ronald Kessler et al., “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication”, –Archives of General Psychiatry, 2005, Vol. 62, No. 6.
• “By 2003, 54% of people with mental health issues were served in the general medical sector only, rather than within or in combination with the specialty mental health sector.”
  • Barbara Mauer, “Mind and Body Reunited: Improving Care at the Behavioral and Primary Care Interface”, prepared for the American College of Mental Health Administration Summit, March 2007.
• A national survey found that 32% of undiagnosed, asymptomatic adults would likely turn to their primary care physician to help with mental health issues; only 4% would approach a mental health professional.
  • Mental Health Association, America’s Mental Health Survey, conducted by Roper Starch Worldwide, 2000.
• Primary care physicians (i.e., family physicians, general internists, and obstetrician-gynecologists) serve as the initial health care provider for between 40% and 60% of individuals with depressive disorders.
  • Virginia Boney, “Psychotherapy: Primary Care Providers = Partner in Treating Depression” Jacksonville Medicine, March, 2002 and SJ Katz et al., “Appropriate medication management of depression in the United States and Ontario” J Gen Intern Med 1998;13:77-85.
• Only 5% of those suffering from a mental disorder see a mental health professional; the other 95% receive treatment from a family physician.
  • R. Lechnyr, “The cost savings of mental health service”, EAP Digest,1993, 22.
• ‘Between 11-36% of all general care physician visits involved patients with diagnosable psychiatric disorders.’
  • L. Eisenberg, “Treating depression and anxiety in primary care”, New England Journal of Medicine, 1992, 326
• When a national sample of 2,031 Australians were asked to rate which professionals were likely to be helpful or harmful for the persons with depression described in a vignette, general practitioners received the highest marks for helpfulness (83%), followed by counselors (74%), psychiatrists (51%) and psychologists (49%)
  • A Jorm et al., “Mental health literacy: a survey of the public’s ability to recognize mental disorders and their beliefs about the effectiveness of treatment.” Med J Aust. 1997; 166(4).
• The 1996 Medical Expenditure Panel Survey found that the risk of depression among people reporting diabetes was two times the risk for individuals without diabetes.
  • Egede LE, Zheng D, Simpson K. “Co-morbid Depression Is Associated with Increased Health Care Use and Expenditures in Individuals with Diabetes.” Diabetes Care, vol. 25, no. 3, 2002 as reported by “Mental Disorders and Medical Co-morbidity”, Robert Woods Johnson Foundation, 2011
• A study of antidepressant utilization in a national managed care organization (MCO) and its behavioral health subsidiary (BHS) found that 77% of all antidepressant prescriptions were written by primary care providers.
  • Karen Way, et al. Antidepressant utilization patterns in a national managed care organization. Drug Benefit Trends 1999; 11(9).
• “When rigorous criteria are applied, between 5.8% and 22.3% of patients in primary care are found to suffer from a diagnosable depressive disorder.”
  • Mark Olfson et al., “The treatment of depression: prescribing practices of primary care physicians and psychiatrists”, Journal of Family Practice, Dec., 1992.
• In 2004, ninety-five percent of primary clinics in California reported providing mental health care.
  • California Primary Care Association based on 2004 OSHPD data.
• “Service utilization studies suggest that 70-80% of the general population will make at least one primary care visit annually. The conclusion is that at approximately 65-70% of patients with mental disorders are cycling through the general medical sector, whether they are recognized and treated or not. These patients, as a rule, do not seek specialty mental health care to address their behavioral health needs.”
  • K. Strosahl, “Building Primary Care Health Delivery Systems that Work: A Compass and a Horizon”, inBehavioral Health in Primary Care: A Guide for Clinical Integration, pgs 37-58, 1997.
• Of the 804 reporting California primary clinics, 73% bill for some mental health encounters, but only 27% (226) report employing mental health professionals.
  • California Primary Care Association based on 2004 OSHPD data.
• The prevalence of borderline personality disorder in primary care is about four times higher than that found in studies of the general community.
  • Raz Gross, “Borderline Personality Disorder in Primary Care”, Arch. Internal Medicine, 2002, 162.
• Major depression occurs in 3% to 6% of community respondents, 5% to 10% of primary care patients, and 10% to 15% of chronically medically ill patients.
  • Wayne Katon et al., “Impact of major depression on chronic medical illness” J Psychosom Res. 2002.
• Total ambulatory costs were 43% to 52% higher and total ambulatory and inpatient costs were 47% to 51% higher in older depressed primary care clients compared with a comparable group who were not depressed after adjustment for chronic medical illness. This increase was seen in every component of health care costs, with only a small percentage due to mental health treatment.
  • Wayne Katon el al., “Increased Medical Costs of a Population-based Sample of Depressed Elderly Patients”,Arch Gen Psychiatry, 2003, 60(9).
• “Depression is particularly prevalent in primary care patients with prevalence rates of 10% or greater. Studies conducted in primary care settings suggest that only about 50% of depressed patients are recognized.
  • Leonard E. Egede, “Failure to Recognize Depression in Primary Care: Issues and Challenges”, J Gen Intern Med. 2007 May; 22(5):
• Family physicians alone only detected major depression in their clients 34.9% of the time.
  • J Coyne et al., “Nondetection of depression by primary care physicians reconsidered:, Gen Hosp Psychiatry. 1995 Jan; 17(1):1-2.
• “Only one-third or fewer of those with depression seeing a general medical provider reported being on an antidepressant and having four or more visits to that provider.
  • Daniel Ford, “Managing Patients with Depression: Is Primary Care Up to the Challenge?” Gen Intern Med. 2000 May; 15(5).
• According to a national survey of 3239 adults conducted by Roper for the National Mental Health Association, “only 18% who appear to have met the diagnostic criteria for clinical depression and/or generalized anxiety disorder at some point in their lives have ever received an official diagnosis or treatment for either condition.”
  • National Mental Health Association News Release, 2001.
• Although only a minority of people affected by depression seek professional help, depressed people are significantly more likely than others to visit physicians for other reasons.
  • Surgeon General’s Mental Health Report, 1999.
• “Over 70% of elderly suicide victims committed suicide within one month of seeing their health care practitioner. Many of these people were not referred or treated for depression by that health care practitioner.”
  • Paper by Thomas Day, Director of the National Care Planning Council “About Medical Care for the Elderly”.
• Between 40 and 70% of elderly who committed suicide saw their general practitioner in the thirty days preceding their death.
  • Howard Cattell, “Suicide in the Elderly”, Advances in Psychiatric Treatment, 2000, Vol. 6.
• Of 403 primary care clients surveyed, 63% felt that it was “somewhat” or “extremely” important that their physician tries to help them with their emotional distress. Their desire for this help was significantly related to a depression diagnosis Sixty-one percent of all primary care clients surveyed and 69% of depressed clients desired counseling, but relatively few desired a referral to a mental health specialist.
  • D. Brody et al., “Patients’ perspectives on the management of emotional distress in primary care settings”,Gen Internal Medicine, 1997, Jul 12 (7).
• 70% of U.S. adolescents see a primary care provider at least once a year, putting their primary care provider in a unique position to prevent youth suicide.
  • D. Frankenfield et al., “Adolescent Patients–Healthy or Hurting? Missed Opportunities to Screen for Suicide Risk in the Primary Care Setting” Arch Pediatrics Adolescent Medicine 2000; 54
• A national survey of over 20,000 adults found that 14% reported use of mental health or addiction services in one year. Slightly more were likely to receive such services from general medical physicians than from specialists in mental health or addiction (6.5% vs. 5.9%), leading authors to conclude “Primary Care is a defacto mental health system responsible for care of more patients with mental disorders than the specialty mental health sector.”
  • D.Regier, Arch Gen Psychiatry 1993; 50.
• Community health clinics providing mental health services grew from 54% in 1999 to 72% in 2004; this represents a 139% growth in mental health clients and a 76% increase in mental health visits.   
  • Barbara Mauer et al, “Behavioral Health and Primary Care Integration 101: Organizational Models from the Field”,  presented at the NCCBH Conference, 2006.
• Anxiety alone and anxiety with depression (but not depression alone) were found to be significant risk factors for substance abuse in a large epidemiological study involving 13,436 subjects.
  • A. K. Knudsen et al., “Common Mental Disorders and Long-Term Sickness Absence in a General Working Population: The Hordaland Health Study”, Acta Psychiatrica Scandinavica, 2012.
• Two-thirds of primary care physicians could not access mental health services for their patients, a rate that was at least twice as high as for other services.
  • P.Cunningham, Health Affairs, 2009, 28, no. 3: w490-501