Graham Center One-Pager

Family Physicians Are an Important Source of Mental Health Care



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2003 Apr 1;67(7):1422.

While comprising about 15 percent of the physician workforce, family physicians provided approximately 20 percent of physician office-based mental health visits in the United States between 1980 and 1999. This proportion has remained stable over the past two decades despite a decline in many other types of office visits to family physicians. Family physicians remain an important source of mental health care for Americans.

According to the Institute of Medicine, mental health care is indivisible from primary medical care. Family physicians and general practitioners (FP/GPs) provide more office-based primary medical care than any other medical specialty. To characterize this care, data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for the contribution made by FP/GPs towards the mental health care of Americans over a 20-year period. The NAMCS was conducted twice from 1980 to 1984, twice from 1985 to 1989, and annually since 1990. NAMCS data allow analysis of physicians' mental health diagnoses coded as the first diagnosis for each office visit, undistorted by billing considerations.

Of all office-based physician visits from 1980 to 1999 with a mental health problem reported as the first diagnosis, approximately 20 percent were provided by FP/GPs. The remaining 80 percent were distributed among all other medical specialties. Of note, these data do not include mental health care provided by psychologists. This distribution has remained stable over a 20-year period that included mental health “carve-out” systems and managed care. In contrast, FP/GP visits as a proportion of total physician visits for any diagnosis have decreased from 32.9 percent in 1980 to 1985 to 24.6 percent in 1995 to 1999.

Psychophysiologic diseases, schizophrenic disorders, acute stress reactions, and hyperkinetic syndromes are increasingly managed by family physicians, while care for depressive and neurotic disorders remains about the same (Table 1).

TABLE 1

Percentage of Total Office Visits for Mental Health Diagnoses by FP/GPs vs. All Other Medical Specialties: 1980 to 1999

Five-year periods Percentage of mental health visits to FP/GPs Percentage of mental health visits to other specialties

1980 to 1984

20.8

79.2

1985 to 1989

17.6

82.4

1990 to 1994

19.2

80.8

1995 to 1999

19.3

80.7


FP/GP = family physician/general practitioner.

TABLE 1   Percentage of Total Office Visits for Mental Health Diagnoses by FP/GPs vs. All Other Medical Specialties: 1980 to 1999

View Table

TABLE 1

Percentage of Total Office Visits for Mental Health Diagnoses by FP/GPs vs. All Other Medical Specialties: 1980 to 1999

Five-year periods Percentage of mental health visits to FP/GPs Percentage of mental health visits to other specialties

1980 to 1984

20.8

79.2

1985 to 1989

17.6

82.4

1990 to 1994

19.2

80.8

1995 to 1999

19.3

80.7


FP/GP = family physician/general practitioner.

Family physicians have been and remain an important source of mental health care for Americans (Table 2).

TABLE 2

Percentage of Total Office Visits for Specific Mental Health Diagnoses Provided by FP/GPs: 1980 to 1999

Mental health diagnoses 1980 to 1984 (%) 1985 to 1989 (%) 1990 to 1994 (%) 1995 to 1999 (%)

Psychophysiologic diseases*

21.0

46.1

26.5

48.2

Schizophrenic disorders

4.1

5.1

7.4

8.4

Special symptoms†

43.1

47.4

46.9

39.2

Acute stress reactions

29.5

28.2

24.1

33.0

Depressive disorders

36.3

34.0

42.0

37.9

Neurotic disorders‡

22.8

21.2

20.4

22.9

Hyperkinetic syndromes§

7.4

11.8

19.3

19.7


FP/GP = family physician/general practitioner.

*—Musculoskeletal, skin, gastrointestinal, endocrine, genitourinary, cardiovascular, or respiratory disorders arising from mental disorders.

†—Stammering, stuttering, tics, and anorexia nervosa and other eating disorders.

‡—Anxiety, hysteria, obsessive-compulsive disorders, hypochondriasis.

§—Attention-deficit disorder of childhood, hyperkinetic conduct disorder of childhood.

TABLE 2   Percentage of Total Office Visits for Specific Mental Health Diagnoses Provided by FP/GPs: 1980 to 1999

View Table

TABLE 2

Percentage of Total Office Visits for Specific Mental Health Diagnoses Provided by FP/GPs: 1980 to 1999

Mental health diagnoses 1980 to 1984 (%) 1985 to 1989 (%) 1990 to 1994 (%) 1995 to 1999 (%)

Psychophysiologic diseases*

21.0

46.1

26.5

48.2

Schizophrenic disorders

4.1

5.1

7.4

8.4

Special symptoms†

43.1

47.4

46.9

39.2

Acute stress reactions

29.5

28.2

24.1

33.0

Depressive disorders

36.3

34.0

42.0

37.9

Neurotic disorders‡

22.8

21.2

20.4

22.9

Hyperkinetic syndromes§

7.4

11.8

19.3

19.7


FP/GP = family physician/general practitioner.

*—Musculoskeletal, skin, gastrointestinal, endocrine, genitourinary, cardiovascular, or respiratory disorders arising from mental disorders.

†—Stammering, stuttering, tics, and anorexia nervosa and other eating disorders.

‡—Anxiety, hysteria, obsessive-compulsive disorders, hypochondriasis.

§—Attention-deficit disorder of childhood, hyperkinetic conduct disorder of childhood.

note: The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Adapted from Graham Center One-Pager #19. Subramanian A, Green LA, Fryer GE, Dovey SM, Phillips RL. Family physicians are an important source of mental health care. March 2003. Available at: www.graham-center.org/x397.xml. From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 1350 Connecticut Ave., NW, Suite 950, Washington, DC 20036 (telephone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).

 

Copyright © 2003 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

More in Pubmed

Navigate this Article