How many affected persons attend primary care?

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About 230 per thousand of the adult population attend primary care each year with a psychiatric disorder. Put in another way, Shepherd et al. (1966) in a seminal paper, estimated that in one year about 10% of adults registered with a general practitioner consult for a condition that is wholly psychiatric, and 5% consult with a disorder with a both psychiatric and physical components. More recently, Ustun and Sartorius (1995) estimated that about a quarter of attenders in primary care have at least one psychiatric disorder diagnosed by ICD-10 criteria, most being anxiety and depressive disorders.

Strathdee and Jenkins (1996) looked more closely at the frequency of various disorders in primary care and estimated that, for a practitioner with a list of 2000, there would be among the adult attenders:

•  60-100 with depression

•  70-80 with anxiety

•  50-60with situational reactions;

•  2-4 with schizophrenia;

•  6-7 with affective psychosis;

•  4-5 with alcohol or drug dependence.

Similar findings have been reported for children. Among those' aged 7-12 years attending primary care, almost a quarter had psychiatric disorder, divided about equally into emotional, conduct, and mixed conduct and emotional disorders (Garralda and Bailey 1986). Among adolescents attending general practice, about a third had a psychiatric disorder (Garralda 1994). As with adults, many of the children and adolescents with psychiatric disorder complain of physical symptoms, and in some of these cases the psychiatric disorder is not detected.