Prevalence of anxiety, depression, and substance use disorders in an urbangeneral medicine practice

Background: Most research on the prevalence of mental disorders in primary care has been conducted in practices that serve middle- and upper-income pa tients. Objective: To determine the prevalence of major mental disorders in a prima ry care practice that serves a predominantly low-income immigrant patient p opulation. Design: Cross-sectional survey; criterion standard. Setting: Urban general medicine practice. Participants: Systematic sample of consecutive adult patients with schedule d appointments. Of 1266 approached eligible patients, 1007 (80%) participat ed. Main Outcome Measures: PRIME-MD Patient Health Questionnaire major depressi on, generalized anxiety disorder, panic disorder, alcohol use disorder, and suicidal ideation; drug use disorder; functional status; work loss; family distress; and mental health treatment. Results: Major depression (18.9%), generalized anxiety (14.8%), panic (8.3% ), and substance use (7.9%) disorders and suicidal ideation (7.1%) were hig hly prevalent. Many patients had more than 1 disorder (range, 36.3% [substa nce use disorder] to 76.9% [panic disorder]). In multivariate analyses, eac h disorder was significantly associated with an increase in impairment afte r controlling for demographic characteristics, perceived health, and the ot her disorders. A minority of patients with each disorder (range, 22.5% [sub stance use disorder] to 46.4% [panic disorder]) reported receiving mental h ealth treatment in the last month. Conclusions: Clinically significant depression, anxiety, substance use, and suicidal ideation are quite common in this practice and associated with si gnificant functional impairment. Primary care practices that serve poor urb an immigrant populations have a critical need to provide access to mental h ealth services.