THE PREVALENCE OF MENTAL-DISORDERS IN RURAL OFFICE PRACTICE

OBJECTIVE: To determine the prevalence of mental disorders in rural pr imary care office practice. DESIGN:Patient interview; chart review. SE TTING: Two rural primary care office practices. PATIENTS: Three hundre d-fifty scheduled or walk-in patients age 18 years or older. MEASUREME NTS: Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-3 6), the Primary Care Evaluation of Mental Disorders (PRIME-MD), physic al health using Greenfield's index of coexistent disease (ICED), and h ealth care utilization using the number of office visits and total off ice and laboratory charges six months before until six months after th e interview. RESULTS: Of these patients 34% met criteria for one or mo re of the 18 mental disorders evaluated by the PRIME-MD; 19% met crite ria for specific disorders according to criteria from the Diagnostic a nd Statistical Manual of Mental Disorders, Revised Third Edition (DSM- III-R). Mood disorders were most common (21.7%), followed by anxiety d isorders (12.3%), somatoform disorders (11.1%), probable alcohol abuse or dependence (6.0%), and eating disorders (2.0%). By logistic regres sion, there was an association of age, sex, race (black), and educatio n with lower prevalence of various mental disorder categories. Even af ter adjustment for demographic variables and physical health (ICED sco re), those with PRIME-MD diagnoses had significantly lower function as measured by the eight MOS SF-36 scales and higher utilization of offi ce services (p < .001). CONCLUSIONS: The prevalence of mental disorder s in rural primary care office practice is as high as in urban office practice.