A nationwide analysis of 350 million patient encounters reveals a high volume of mental-health conditions in primary care

Abstract

How many primary-care encounters are devoted to mental-health conditions compared with physical-health conditions? Here we analyzed Norway's nationwide administrative primary-care records, extracting all doctor-patient encounters occurring during 14 years (2006-2019) for the population aged 0-100 years. Encounters were recorded according to the International Classification of Primary Care. We compared the volume of mental-health encounters against volumes for conditions in multiple different body systems. A total of 4,875,722 patients generated 354,516,291 encounters. One in 9 encounters (11.7%) involved a mental-health condition. Only musculoskeletal conditions accounted for a greater share of primary-care physicians' attention. The volume of mental-health encounters in primary care equaled encounters for infections, cardiovascular and respiratory conditions and exceeded encounters for pain, injuries, metabolic, digestive, skin, urological, reproductive and sensory conditions. Primary-care physicians frequently treat complex mental-health conditions in patients of every age. These physicians may have a more important role in preventing the escalation of mental-health problems than heretofore appreciated.

Keywords: Epidemiology; Health services; Psychiatric disorders.

Fig. 1. An analysis of primary-care encounters.

a, The International Classification of Primary Care (ICPC-2), which focuses on conditions that are encountered in primary care and which are coded into chapters representing body systems. b, The flow chart of medical conditions studied in this nationwide analysis of health encounters in general practices.

Fig. 2. Patient-level analysis: proportion of patients who present to PCPs with mental-health conditions.

a, The proportion of patients presenting with different mental-health conditions (Supplementary Table 4). b, The distribution of mental-health conditions over the lifespan, as a function of age.

Fig. 3. Encounter-level analysis: proportion of primary-care encounters devoted to mental health.

a, The proportion of 41,616,704 mental-health encounters devoted to each of 24 different mental-health conditions (Supplementary Table 5). b, Mental-health encounters generated by patients at every point over the lifespan.

Fig. 4. How does the number of primary-care encounters for mental-health conditions compare to the number of encounters for other conditions that PCPs see in their practice?.

a, Comparison of the volume of PCPs’ mental-health encounters to encounters for medical conditions in 15 different body systems (Supplementary Table 6). b, Comparison of the volume of PCPs’ mental-health encounters to encounters for medical conditions in 15 different body systems, over the lifespan as a function of patient age. c, Comparison of the volume of PCPs’ mental-health encounters to encounters for infections, pain and injuries, throughout the body (Supplementary Table 7).