Mental health in the Dutch population and in general practice: 1987-2001.
BACKGROUND
In the last 15 years, both the demand for and supply of specialised mental health care increased considerably in the Netherlands. Increased demand may reflect a change in psychological morbidity, but may also be a consequence of increased supply. Specialised health care in the Netherlands is accessible only through referral by a GP, and so it is important to consider the role of primary care in the diagnosis of mental health problems.


OBJECTIVE
The aim of this study is to achieve a better understanding of the development of mental health status in the Dutch population and the consequent help-seeking behaviour in primary care.


METHODS
Using two comparable morbidity studies carried out in the Dutch population and in primary care, we compared data from 1987 and 2001 to assess the following: possible differences in mental health between 1987 and 2001; possible differences in prevalence of mental disorder as diagnosed by GPs in 1987 and 2001; possible differences in the sociodemographic determinants of mental health and mental disorder in primary care between 1987 and 2001.


RESULTS
Our results show an increase in mental and social problems in the population between 1987 and 2001. However, GPs diagnosed fewer patients as having a mental disorder in 2001 than they did in 1987. The risk of mental disorders or social problems in several sociodemographic groups remained largely the same, as did the chance of receiving a psychological or social diagnosis.


CONCLUSIONS
We conclude that, while mental disorder in the population is increasing, the role of primary care has changed. Although GPs diagnose a lower percentage of mental problems as such, they refer an increasingly larger proportion of these to secondary care.
Verhaak
Peter F M
PF
Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands. p.verhaak@nivel.nl
Hoeymans
Nancy
N
Garssen
Anna A
AA
Westert
Gert P
GP
D000293:Adolescent; D000328:Adult; D000368:Aged; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000639:trends; D006306:Health Surveys; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration* / Q000639:trends; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011795:Surveys and Questionnaires