The prevalence of common mental and substance use disorders in general practice: a literature review and discussion paper

Abstract

Enhanced primary care management of common mental and substance use disorders is a key healthcare target. Though primary care may be well placed to achieve this target, a greater understanding of the prevalence and profile of common mental and substance use disorders in primary care settings is needed. We searched the MEDLINE database (2002–2012) to provide an update on biomedical literature describing the prevalence of common mental and substance use disorders in European general practice. Following “PRISMA” guidelines, 17 studies were kept for qualitative synthesis. Prevalence, profile, screening instruments, associated co-morbidities, and gender distribution were tabulated. Depending on the screening method, the prevalence of common mental and substance use disorders ranged from 10.4% (Luxemburg) to 53.6% (Spain). Mood disorders were the most common. High co-morbidity with anxiety and somatisation hindered early identification and management. The continuing burden of common mental and substance use disorders, coupled with poor identification described in the updated EU biomedical literature, suggests that the unmet need for health care – identified by the World Health Organization a decade ago – remains unmet. Understanding the prevalence of common mental and substance use disorders, associated morbidity, and the extent to which general practice represents an important catchment mechanism can enhance their management at this level. General practitioners should be trained in accurate screening. Short screening instruments for general practitioners should be unified and promoted.

Keywords:

• prevalence
• epidemiology
• general practice
• family practice
• primary health care
• psychiatry
• common mental and substance use disorders
• screening

Acknowledgements

AN participated in the design of the study, performed the literature review, classified the findings, and drafted the manuscript. JK participated in the design of the study and contributed to the manuscript. CM and DM contributed to the manuscript. WC conceived of the study, participated in its design and coordination, and contributed to the manuscript. All authors read and approved the final manuscript.

Funding

This work was supported by research grants from Health Research Board of Ireland, HRA_HSR/2012/14, the Research Incentives Programme at University of Limerick, and the University of Limerick Graduate Entry Medical School Strategic Research Fund, and from Irish Research Council, Government of Ireland “New Foundations” Scheme 2013 (PINTA-TOUR).