BACKGROUND: The prevalence of major psychiatric disorders in the general population is difficult to pinpoint owing to widely divergent estimates yielded by studies employing different criteria, methods, and instruments. Depressive disorders, which represent a sizable mental health care expense for the public purse, are no exception to the rule. METHODS: The prevalence of depressive disorders was assessed in a representative sample (n = 4972) of the U.K. general population in 1994. Interviews were performed over the telephone by lay interviewers using an expert system that tailored the questionnaire to each individual based on prior responses. Diagnoses and symptoms lists were based on the DSM-IV. RESULTS: Five percent (95% confidence interval = 4.4-5.6%) of the sample was diagnosed by the system with a depressive disorder at the time of the interview, with the rate slightly higher for women (5.9%) than men (4.2%). Unemployed, separated, divorced, and widowed individuals were found to be at higher risk for depression. Depressive subjects were seen almost exclusively by general practitioners (only 3.4% by psychiatrists). Only 12.5% of them consulted their physician seeking mental health treatment, and 15.9% reported being hospitalized in the past 12 months. CONCLUSIONS: The study indicates that mental health problems in the community are seriously underdetected by general practitioners, and that these professionals are highly reluctant to refer patients with depressive disorders to the appropriate specialist.
BACKGROUND: The prevalence of major psychiatric disorders in the general population is difficult to pinpoint owing to widely divergent estimates yielded by studies employing different criteria, methods, and instruments. Depressive disorders, which represent a sizable mental health care expense for the public purse, are no exception to the rule. METHODS: The prevalence of depressive disorders was assessed in a representative sample (n = 4972) of the U.K. general population in 1994. Interviews were performed over the telephone by lay interviewers using an expert system that tailored the questionnaire to each individual based on prior responses. Diagnoses and symptoms lists were based on the DSM-IV. RESULTS: Five percent (95% confidence interval = 4.4-5.6%) of the sample was diagnosed by the system with a depressive disorder at the time of the interview, with the rate slightly higher for women (5.9%) than men (4.2%). Unemployed, separated, divorced, and widowed individuals were found to be at higher risk for depression. Depressive subjects were seen almost exclusively by general practitioners (only 3.4% by psychiatrists). Only 12.5% of them consulted their physician seeking mental health treatment, and 15.9% reported being hospitalized in the past 12 months. CONCLUSIONS: The study indicates that mental health problems in the community are seriously underdetected by general practitioners, and that these professionals are highly reluctant to refer patients with depressive disorders to the appropriate specialist.