STRATEGIES FOR THE PREVENTION OF PSYCHIATRIC-DISORDER IN PRIMARY-CAREIN SOUTH LONDON

Study objective-To compare the potential impact of high risk and popul ation based approaches to the prevention of psychiatric disorder, usin g a representative sample of general practice attenders as the target population. Design-This was a prospective cohort study. Setting-A heal th centre in south London. Participants-Three hundred and seven consec utive attenders aged 16-65, recruited at randomly selected general pra ctice surgeries. Main results-A linear association was found between t he number of different types of socioeconomic adversity reported at re cruitment (T1) and the prevalence of psychiatric disorder one year lat er (T2). The population attributable fraction (PAF) for socioeconomic adversity at T1 was 37.4%. In theory, social interventions for high ri sk individuals at T1 would reduce the prevalence of psychiatric disord er at T2 by 9% at most, compared with a reduction of 18% if just one i tem of socioeconomic adversity were eliminated among those with any so cioeconomic risk factors. Conclusions-Social interventions targeted at individuals at highest risk of the most common mental disorders are l ikely to be extremely limited in their capacity to reduce the prevalen ce of these conditions. A population based risk reduction strategy, mo dified according to individual risk, represents a potentially feasible and effective alternative.