Strategies for the prevention of psychiatric disorder in primary care in south London.
OBJECTIVE
To compare the potential impact of high risk and population based approaches to the prevention of psychiatric disorder, using a representative sample of general practice attenders as the target population.


METHODS
This was a prospective cohort study.


METHODS
A health centre in south London.


METHODS
Three hundred and seven consecutive attenders aged 16-65, recruited at randomly selected general practice surgeries.


RESULTS
A linear association was found between the number of different types of socioeconomic adversity reported at recruitment (T1) and the prevalence of psychiatric disorder one year later (T2). The population attributable fraction (PAF) for socioeconomic adversity at T1 was 37.4%. In theory, social interventions for high risk individuals at T1 would reduce the prevalence of psychiatric disorder at T2 by 9% at most, compared with a reduction of 18% if just one item of socioeconomic adversity were eliminated among those with any socioeconomic risk factors.


CONCLUSIONS
Social interventions targeted at individuals at highest risk of the most common mental disorders are likely to be extremely limited in their capacity to reduce the prevalence of these conditions. A population based risk reduction strategy, modified according to individual risk, represents a potentially feasible and effective alternative.
Weich
S
S
Section of Epidemiology and General Practice, Institute of Psychiatry, London.
Lewis
G
G
Churchill
R
R
Mann
A
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D012959:Socioeconomic Factors