n most health care systems, primary care doc-tors are the cornerstone of recognition, diagnosis, treat-ment, and specialist referral for all types of disorders,whether they are somatic, psychological, or both. Thepast two decades have witnessed a further emphasis ofthis role, particularly with regard to the treatment ofmental disorders in primary care. Several reasonsaccount for this. First, mental disorders are extremelyprevalent in the community, and much more than previ-ously thought. Current epidemiological findings suggestthat almost 50% of the population will experience atleast one mental disorder in their lifetime, and at least25% have suffered from a mental disorder during thepast 12 months.1-3 Second, international epidemiologicalevidence suggests that, of all the people with mental dis-order who receive treatment, a large proportion obtainat least minimal intervention through their primary caredoctor.4,5 Third, the continuing trend of reducing psychi-atric hospital beds contributes to a larger burden of psy-chiatric patients in outpatient and, particularly, primarycare settings. Finally, the rapidly accumulating knowl-edge in clinical neuroscience and clinical psychology hasresulted in various new treatment options for a widerange of neuropsychiatric conditions and disorders, andmany of these can be applied in primary care.In most systems, the majority of people report at leastone primary care visit per year, thereby maintaining astable and enduring relationship. On this basis, the gen-eral practitioner (GP) may develop a deeper under-standing of individual vulnerability for certain diseases,illness behavior, the waxing and waning of disorders, thedevelopment of somatic and mental comorbidities, andthe ability to overcome the direct and indirect effects ofdiseases. GPs also frequently have a more intimateknowledge of the psychosocial context in which patients’distress and illnesses occur (ie, interpersonal and familycrises, occupational and employment problems, andS t a t e o f t h e a r t1 1 5Mental disorders in primary careHans-Ulrich Wittchen, Dipl Psych, PhD; Stephan Mühlig, Dipl Psych, PhD;Katja Beesdo, Dipl PsychKeywords: primary care; mental disorder; recognition; managementAuthor affiliations: Institute for Clinical Psychology and Psychotherapy,Dresden University of Technology, Dresden, Germany (Hans-Ulrich Wittchen,Stephan Mühlig, Katja Beesdo); Max Planck Institute of Psychiatry, ClinicalPsychology and Epidemiology, Munich, Germany (Hans-Ulrich Wittchen)Address for correspondence: Prof Dr Hans-Ulrich Wittchen, Institute ofClinical Psychology and Psychotherapy, Technical University of Dresden,Chemnitzerstrasse 46, D-01187 Dresden, Germany(e-mail: wittchen@mpipsykl.mpg.de)ICurrent estimates indicate that 50% of the populationexperience at least one mental disorder in their lifetimeand that at least 25% have suffered a mental disorder inthe past year. Recognition, diagnosis, treatment, andreferral depend overwhelmingly on general practitioners,at least one third of whose consultations have a direct andexplicit psychological component. Yet despite this inten-sive familiarization with the presentation of mentalpathology, and the appropriateness of the primary caresetting to its management, even the most recent surveysindicate that performance is best described by the rule ofdiminishing halves: only half the patients with a thresh-old disorder are recognized; only half of those recognizedare treated; and only half of those treated are effectivelytreated. There is no single solution to this problem, onlymultiple solutions, which must be aimed, consistently andsimultaneously, at the patient, practitioner, practice, andresearch levels.Dialogues Clin Neurosci. 2003;5:115-128.
Alert