Research evaluating millions of patients’ visits to primary care doctors reveals that mental health issues rank just below musculoskeletal problems in terms of frequency in standard care. For every nine patients, one is primarily seeking help for mental health matters.
“Primary care doctors serve as the first point of contact,” explained study lead Avshalom Caspi, who holds the Edward M. Arnett Professorship of Psychology and Neuroscience at Duke University. “The data from primary care allows us to understand the initial interactions people have with the healthcare system.”
The research analyzed over 350 million visits from 4.8 million individuals between January 2006 and December 2019, as documented by the Norwegian government. Physicians recorded each visit’s main health issue, granting researchers a chance to closely investigate the everyday realities these doctors face. The findings are set to be published on September 19 in Nature Mental Health.
“Our goal was to identify which body parts were being treated,” said Caspi, who has also developed a method for assessing the aging process. “We discovered that 12% of all visits to primary care doctors are related to mental health issues, amounting to over 40 million instances from the 350 million total encounters.”
The data, which covered a span of 14 years concluding in 2019—prior to the pandemic—reflects a distinctly Norwegian demographic benefiting from a socialized healthcare system. Norway is among the wealthiest nations globally, has virtually no extreme poverty, and ranks seventh on a worldwide happiness index, while the U.S. doesn’t appear in the top 20.
Nonetheless, this insight into the role of mental health in routine primary care is still significant, Caspi noted. “The data represents a comprehensive record of individuals aged from birth to 100, across various backgrounds.”
The frequency of mental health concerns was comparable to those visiting for respiratory and cardiovascular issues and exceeded those presenting with infections, injuries, digestive, skin, urological, or sensory problems.
Caspi emphasized that the most notable takeaway is that the number of mental health visits seen by primary care physicians ranks just after physical ailments. Although these visits often pertain to depression or anxiety, physicians encounter “a range of complex conditions,” including psychosis. “The depth of the mental health issues that primary care physicians address truly astonishes me,” he remarked.
Conditions like depression, sleep disruptions, stress, anxiety, memory challenges, and substance abuse topped the list. Other concerns included ADHD, learning difficulties, post-traumatic stress disorder, eating disorders, sexual health issues, psychosis, and thoughts of self-harm.
Caspi also pointed out that “this isn’t confined to one specific point in a person’s life; it spans all ages.” Mental health issues were most common in individuals in their 40s, with one in five visits to primary care doctors related to mental health.
“Each day, primary care physicians encounter mental health issues across all age groups—from pediatric to geriatric patients and middle-aged adults,” noted Caspi.
Dr. Damon Tweedy, a psychiatry and behavioral sciences professor at Duke Health who was not part of the study, said, “This report highlights an increasingly clear issue in healthcare: without specific strategies to enhance mental health services in primary care settings, the healthcare system will fall short of meeting the needs of those it serves.”
Malinda Teague, an assistant clinical professor in the Duke School of Nursing who was not involved in the study, stated that this trend is apparent in pediatric care post-pandemic. “Even during standard well-child visits, nearly every child is seen with some behavioral, anxiety, or depression concern.”
While Caspi refrains from insisting that primary care doctors need extensive training in mental health, he would advocate for better integration of mental health specialists into the primary care framework. “Imagine visiting your general practitioner for a mental health issue and being directed down the hall for support. That’s called a warm handoff, and the VA has implemented this successfully.”
Teague supports this integration, noting that Duke pediatric primary care has adopted a similar model, but she believes it falls short. “The embedded mental health providers are quickly reaching their limits and cannot assist all patients in need. Primary care providers must become competent and assured in addressing common mental health conditions to ensure their patients have access to necessary care.”
“The American Academy of Pediatrics recommended a few years ago that every child aged 12 and older should be screened for depression at each visit,” Teague said. “However, in reality, this rarely occurs. When someone visits for an ear infection or cough, who is checking for their mental health? Due to our fee-for-service model, time constraints during patient visits hinder these screenings, resulting in them only happening during annual check-ups, leading us to miss out on substantial opportunities for intervention.”
Regardless, Caspi urged patients to discuss their mental health concerns with their doctors. “Don’t hesitate,” he advised. “These doctors are encountering such issues regularly.”
