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Am Fam Physician. 2003;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).

Five-year periodsPercentage of mental health visits to FP/GPsPercentage of mental health visits to other specialties
1980 to 198420.879.2
1985 to 198917.682.4
1990 to 199419.280.8
1995 to 199919.380.7

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

Mental health diagnoses1980 to 1984 (%)1985 to 1989 (%)1990 to 1994 (%)1995 to 1999 (%)
Psychophysiologic diseases*21.046.126.548.2
Schizophrenic disorders4.15.17.48.4
Special symptoms†43.147.446.939.2
Acute stress reactions29.528.224.133.0
Depressive disorders36.334.042.037.9
Neurotic disorders‡22.821.220.422.9
Hyperkinetic syndromes§7.411.819.319.7

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

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Graham Center Policy One-Pagers published in AFP is available at https://www.aafp.org/afp/graham. One-Pagers are also available at https://www.graham-center.org.

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