Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice.
BACKGROUND
Most research on the prevalence of mental disorders in primary care has been conducted in practices that serve middle- and upper-income patients.


OBJECTIVE
To determine the prevalence of major mental disorders in a primary care practice that serves a predominantly low-income immigrant patient population.


METHODS
Cross-sectional survey; criterion standard.


METHODS
Urban general medicine practice.


METHODS
Systematic sample of consecutive adult patients with scheduled appointments. Of 1266 approached eligible patients, 1007 (80%) participated.


METHODS
PRIME-MD Patient Health Questionnaire major depression, generalized anxiety disorder, panic disorder, alcohol use disorder, and suicidal ideation; drug use disorder; functional status; work loss; family distress; and mental health treatment.


RESULTS
Major depression (18. 9%), generalized anxiety (14.8%), panic (8.3%), and substance use (7. 9%) disorders and suicidal ideation (7.1%) were highly prevalent. Many patients had more than 1 disorder (range, 36.3% [substance use disorder] to 76.9% [panic disorder]). In multivariate analyses, each disorder was significantly associated with an increase in impairment after controlling for demographic characteristics, perceived health, and the other disorders. A minority of patients with each disorder (range, 22.5% [substance use disorder] to 46.4% [panic disorder]) reported receiving mental health treatment in the last month.


CONCLUSIONS
Clinically significant depression, anxiety, substance use, and suicidal ideation are quite common in this practice and associated with significant functional impairment. Primary care practices that serve poor urban immigrant populations have a critical need to provide access to mental health services. Arch Fam Med. 2000;9:876-883
Olfson
M
M
New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA.
Shea
S
S
Feder
A
A
Fuentes
M
M
Nomura
Y
Y
Gameroff
M
M
Weissman
M M
MM
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D009518:New York / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013405:Suicide / Q000523:psychology