To describe the epidemiology of mental problems in general practice, from the viewpoint of the general practitioner (GP).
Descriptive population survey.
Data were collected from the National Study of Morbidity and Interventions in General Practice.
In 1987-1988 we used an interview to assess health status and medical consumption of 10,350 persons, aged 15 and over. At the same time they were screened for mental illness using the General Health Questionnaire (GHQ). For three months, all doctor-patient contacts, the reason for contact (classified in ICPC) and the GP's assessment of possible psychological factors in the reason for contact were recorded.
Of the patients with a high GHQ score only one third explicitly mentioned his psychological problems to the GP, 70 were recognized by the GP as having psychological problems in the three month period and besides psychological problems this group showed much more acute and chronic physical illness. Patients scoring high on the GHQ have more symptoms, but in general not other symptoms than mentally ‘healthy’ people have.
Screening-programmes on mental illness are not recommended because of the impossible of determining the groups at risk. Prevention might be possible in patients with a high frequency in doctor-patient contacts and many physical complaints. A public health approach, encouraging patients to discuss psychological problems directly with their GP, might be sensible.