Primary care physicians are faced with an increasing number of mental health problems

A review of millions of patient visits to primary care physicians shows that mental health problems are second only to musculoskeletal complaints in daily care. One in nine patients sought care primarily because of mental health concerns.

These primary care physicians are the gatekeepers. Primary care physician data allows us to see people when they first come into contact with the health system. “

Avshalom Caspi, educational leader, Edward M. Arnett Professor of Psychology and Neuroscience at Duke University

The researchers analyzed more than 350 million primary care visits for 4.8 million people from January 2006 to December 2019, as reported by the Norwegian government. Each health-related visit was documented by the doctors, enabling the researchers to dive deeper into what these doctors see every day. The lesson comes out on September 19 Nature Mental Health.

“The idea was to see which parts of the body they treat,” said Caspi, who developed a strategy to measure the speed of human aging. “It turns out that 12 percent of all appointments that primary care physicians have are for mental health issues. So out of 350 million appointments, they have over 40 million appointments of mental health.”

The data covers 14 years, ending in 2019 – before the pandemic – and shows the population of Norway with public health care. Norway is one of the richest countries in the world, with extreme poverty, and ranks seventh in the list of the happiest countries in the world, while the US is not even in the top 20.

But understanding how much mental health counts in primary care is still important, Caspi said. “This is a comprehensive account of people aged zero to 100, from all walks of life.”

The prevalence of mental health problems was almost equal to the number of visits for respiratory and cardiovascular complaints, and more than for infections, injuries, digestive, skin, urological or problems. he obeys.

Caspi says the bottom line is that many of the mental health problems seen by primary care physicians are secondary to aches and pains. Although it is usually depression or anxiety, they see “various and complex conditions,” including psychosis. “When I look at all of this, I am amazed at the complexity of the mental health issues that primary care physicians have to contend with.”

Depression, sleep disturbance, depression and anxiety, memory problems and substance abuse topped the list. But concerns also included ADHD, learning difficulties, post-traumatic stress disorder, eating disorders, sexual issues, psychosis and suicidal thoughts.

Caspi adds that it’s also important to realize “this doesn’t just happen once in a lifetime, it happens everywhere, among all age groups,” he said. Mental health concerns peaked in the 40s, when one in five visits to a primary care physician were for a mental health problem.

“The primary care physician, on a daily basis, will be faced with mental health problems in pediatric patients, in older patients and among middle-aged adults,” he said. Caspi.

“This report highlights what has become increasingly apparent in medicine: without a targeted effort to expand mental health services within the primary care setting, the medical system will not meet the health needs of the mind of those it serves,” said Dr. Damon Tweedy, a professor of cognitive and behavioral sciences at Duke Health, who was not involved in the study.

In the wake of the pandemic, this practice is also inevitable in pediatric care, said Malinda Teague, an assistant professor of medicine at the Duke School of Nursing, who was not involved in the study. “Even if it’s a regular visit for a well-child, almost every child comes in with behavioral concerns, anxiety, depression.”

Caspi stops short of suggesting that primary care physicians need to be educated more about mental health, but would like to see mental health professionals better integrated into the primary care model. “You go to your GP and you have a mental health problem. And they say ‘let’s go down the hall and set you up.’ That’s called a warm hand, and the VA has been good about that.”

Teague agrees and notes that Duke’s primary child care already has a similar model, but says it’s not enough. “These integrated mental health practitioners are in a hurry to become competent and cannot see all patients in need. Primary care providers must be competent and confident to deal with the situation. common mental health professionals to provide this experience in caring for their patients.”

“The American Academy of Pediatrics recommended several years ago that every child 12 years of age and older should be screened for depression periodically,” Teague said. “However, I’m telling you, that doesn’t happen. You have someone coming in for an ear infection, or someone coming in with a cough. Who’s checking them for depression? Because of our model of pay for services, period. Visiting limits don’t really support that,” he said. “As a result, these reviews only happen at the annual review and we miss many opportunities to help.”

However, Caspi encouraged patients to share their mental health concerns with their doctors. He said: “Do not be ashamed. “Because they see this a lot.”