ELSEVIER Psychiatric Morbidity Among Patients in Primary Care Hasse Karlsson, M.D., M.A., Ville Lehtinen, M.D., and Matti Joukamaa, M.D, Frequent Abstract: In this study, 96 frequent attender patients in pri- may care were compared with 466 other primary care patients. Thefocus was on psychiatricmorbidity, current and former psychiatric treatment, and self-perceived need for treatment. Theprevalence of psychiatric illness wasmuch greateramong frequent attender patients than other patients (54.0% vs. 24.0%, p < 0.001~, and subclinical symptoms were common in both groups (34.0% vs. 43.2%). Depression and anxiety were the mostcommon clinical entities among frequent at- tenderpatients. However,very few patients had psychiatric treatment and the self-perceived need for treatment waslow. Thesignificance of these findings is discussed in the paper. Introduction There are many studies on psychiatric morbidity in primary health care and the internist’s ability to detect these disorders (e.g., [l-8]). Unfortunately, however, the clinical utility of screening question- naires, diagnostic criteria, and physician recogni- tion within the context of primary care is largely unknown [9J. It is also uncertain whether treat- ment trials conducted in specialty settings are rel- evant to assessing the clinical utility of diagnostic criteria when used in primary care [lo]. Often the definition of a psychiatric case by screening instru- ments, primary care physicians, and interview schedules is also not compatible. Furthermore, a great number of primary care patients exhibit psy- chological illness below conventional diagnostic Department of Psychiatry, University of Turku, Turku, Fin- land and Turku Universitv Central Hosnital, Turku, Finland (H.K., V.L.), and Department of PsGchiatry, University of Oulu, Oulu, Finland (M.J.) Address reprint requests to: Hasse Karlsson, Louhimontie 5, 20540 Turku, Finland. General Hospital Psychiatry 17, 19-25, 1995 0 1995 Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 gl;r thresholds [9]. Thus, new research strategies in these settings have been suggested [lo]. One relatively new way to look at this question is to study subpopulations of primary care pa- tients. Only a few papers have been published about the psychiatric morbidity of the patients who burden the primary care system most, namely, the frequent attenders. There are, how- ever, practical reasons for taking this group under careful consideration. These patients use health care facilities most frequently, as demonstrated by many studies [9,11,12], their complaints are often numerous and chronic [H-16] and the doctor- patient relationship is sometimes difficult [17]. Much is known about the social and family sit- uations of frequent attender patients (11,14,18,19]. In a recent paper we reported that frequent atten- dance was associated with little vocational train- ing, low social class, collection of disability pen- sion, and multiple physical diagnoses, but not with any specific physical diagnostic group accord- ing to the ICD-9 [16]. The frequent attenders were also clearly more distressed than other patients in primary health care [20]. These results are largely in accordance with previous studies. Studies on Psychiatric Morbidity of Frequent Attenders The psychiatric morbidity of frequent attender pa- tients has been studied by Katon et al. [15]. With the focus on the distressed frequent attenders (51% of all the frequent attenders), it was discov- ered that 23.5% had major depresstin, 16.8% dys- thymic disorder, 21.8% generalized anxiety disor- 19 ISSN 0163-83#/95/$9.50 SSDI OI63-8343(94)00059-M