High Percentage of Patients Seek Mental Health Care from PCPs, According to New Large Analysis

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Mental health conditions may be more common in primary care settings than previously thought, according to a new analysis of millions of patient visits to their primary health care professionals published in Nature Mental Health.

In the examination of over 350 million primary care visits for 4.8 million individuals in Norway over a 14-year study period, data showed 1 in 9 encounters (11.7%) involved a mental health condition. The only body system that accounted for a greater share of primary care physicians’ (PCPs’) attention was the musculoskeletal system (17.4% of all encounters), according to the study published online September 19, 2024.

The volume of mental-health encounters equaled those for infections, cardiovascular conditions, and respiratory conditions and exceeded visits for pain, injuries, metabolic, digestive, skin, urological, reproductive, and sensory conditions.

“Although many PCPs feel ill-equipped to deliver care that is the province of psychiatric services, they are often the first point of contact for navigating mental-health care,” first author Avshalom Caspi, PhD, Department of Psychology and Neurosciences, Duke University, Durham, North Carolina, and colleagues wrote. “Current efforts to strengthen primary care aim to address mental health and make whole-person care a reality.”

Research on just how much of PCPs’ work is devoted to mental health conditions presents conflicting data, according to Caspi and coauthors. One report from the American Psychological Association claims up to 70% of PCP visits are for mental health concerns, while a survey from the United Kingdom reports they account for 40%.

“To provide information about the volume of mental-health conditions in primary care, we turned to a unique data source: all primary care records in the health system of an entire nation where cost barriers do not generate bias in the subset of unwell individuals who seek care,” Caspi and colleagues explained. The nation they are referring to is Norway, where all residents are assigned to a PCP.

Using the Norwegian Population Register, investigators extracted all codes associated with patient encounters over a 14-year period (2006-2019) for individuals aged 0 to 100 years. In addition to quantifying the volume of encounters related to mental health conditions, researchers compared the number of these encounters to those for medical conditions in 15 different body systems (eg, skin, digestive, eye, and cardiovascular) as well as for encounters for body-wide infections, pain, and injuries.

Findings

The study included a total of 4 875 722 individuals registered with a PCP who generated 354 516 291 primary care encounters. Nearly half (47%, n=2 309 787) of the over 4 million individuals with a PCP presented to primary care for a mental health condition. These patients reported experiencing a full range of mental health issues, from depression to irritability and anger, according to Caspi and colleagues.

Of all the primary care encounters, 11.7% (n=41 616 704) involved a mental health condition. Mental health encounters were not just comprised of the most common mental health disorders. Investigators noted that while about one-third of mental-health encounters involved depression (23.8%) or anxiety (14.1%), the rest included “diverse and complex mental-health complaints, symptoms and disorders” such as sleep disturbances (12.1%), substance abuse (8.3%), and psychosis (6.9%).

When researchers compared mental-health encounters with encounters for other medical conditions, they found that the musculoskeletal system was the only body system that accounted for a greater share of PCPs’ attention (17.4%). Furthermore, the share of mental health encounters was similar to the share of encounters for the cardiovascular system (12.1%), respiratory system (11.0%), and for general/unspecified conditions (10.3%).

Results also showed that PCPs had a similar number of encounters for mental-health conditions as they did for infections (11.7% vs 11.5%). The clinicians had 3-4 times more encounters for mental health conditions than they did for symptoms/complaints of pain (4.8%) or injuries (3.8%), investigators added.

Moreover, investigators observed that “mental-health encounters are generated by patients at every stage of the lifespan.” Many of these encounters were for developmentally-specific conditions, such as developmental delay/learning problems in children and dementia/memory issues in older adults. Other mental-health encounters that were observed across all groups were for depression, anxiety, and sleep disturbance, according to the findings.

“This study adds information about the magnitude of mental-health care in primary care,” Caspi et al concluded. “The large volume of primary-care encounters devoted to diverse mental-health conditions underscores the need for physician training in mental health, for integrated mental-health services and for workforce capacity planning. PCPs may have a more important role in preventing the escalation of mental-health problems than heretofore appreciated.”

Reference: Caspi A, Houts RM, Moffitt TE, et al. A nationwide analysis of 350 million patient encounters reveals a high volume of mental-health conditions in primary care. Nat Ment Health. Published online September 19, 2024. doi:10.1038/s44220-024-00310-5