Acta Psychiatr Scand 1997: 95: 6-12 Printed in UK zyxwvutsrqponm - all rights reserved Copyright zyxw 0 Munksgaard 1997 zy ACTA PSYCHIATRICA SCANDINAVICA ISSN zyx 0001 zyx -690X zy Psychiatric morbidity in primary public health care: a multicentre investigation. Part 11. Hidden morbiditv and J of treatment Munk-Jorgensen zyxwvuts F’, Fink P, Brevik JI, Dalgard OS, Engberg M, Hansson L, Holm M, Joukamaa M, Karlsson H, Lehtinen V, Nettelbladt P, Stefansson C, Sorensen L, Jensen J, Borgquist L, Sandager I, Nordstrom G. Psychiatric morbidity in primary public health care: a multicentre investigation. Part 11. Hidden morbidity and choice of treatment. Acta Psychiatr Scand 1997: 95: 6-12. zyxwvu 0 Munksgaard 1997. A total of 1281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non- psychosis did not influence the GPs’ ability to detect a mental illness. According to the GPs’ assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists. zyxwvu Introduction Several studies have shown that mental illness is highly prevalent in the general population and pri- mary care settings. Most patients initially consult their general practitioner (GP). Therefore,it is impor- tant that GPs are able to identify mental disorders. The majority of individuals with mental illness are treated in primary care, and only a small proportion are referred to specialized services (1-4). Studies of mental illness in primary care settings are thus very important, as the GP appears to be the most centrally placed professional in the mental health care system. Moreover, he or she is the ‘gate- keeper’ to the specialized mental health care sys- tem. Consequently, the GP’s skills in the treatment and diagnosis of mental illness are most important. choice P. Munk-Jsrgensen’, P. Fink’, J. 1. Brevik’, 0. S. Dalgard‘, M. Engberg’, 1. Hansson‘, M. Holm‘, M. Joukamaa’, H. Karlsson’, V. Lehtinen’, P. Nettelbladt‘, C. Stefansson3, L. Ssrensen’, J. Jensen’, 1. Borgquist’, 1. Sandage+, G. Nordstrom‘ ’Department of Psychiatric Demography, Risskov, Denmark, ’Centre for Social Network and Health, Oslo, Norway, 3Psychosocial Research Unit, Stockholm, Sweden, 4Department of Psychiatry, Lund University, Lund, Sweden, ’Department of Psychiatry, University of Turku, Turku. Finland, ‘Institute for General Practice, University of Aarhus. Aarhus, Denmark and 7Department of Community Sciences, University of Lund, Lund. Sweden Key words: mental illness; general practice; hidden psychiatric morbidity; pathways to treatment Povl Munk-Jsrgensen, Institute for Basic Psychiatric Research, Department of Psychiatric Demography, Skovagelvej 2, DK-8240 Risskov, Denmark Accepted for publication March 23, 1996 However, other studies have shown that a sub- stantial proportion of mental disorders in primary care go unrecognized, or else are inadequately diagnosed by the GP. Furthermore, treatment of mental disorders in primary care is often lacking or inadequate, although these cases can, if recog- nized, be treated effectively (5-9). The aims of this part of the study were to compare five Scandinavian GP centres in order (i) to investigate the GPs’ ability to recognize psychiatric cases among patients in primary care, (ii) to analyse the factors that influence the rate of recognition and (iii) to study the type of treatment received by patients with a mental disorder, includ- ing pathways to specialized care. 6