Primary Care In 1946 the World Health Organization (WHO) defined health as "the complete state of physical, mental, and social well-being and not merely the absence of disease." This definition brought together mind and body. In the fifty-five years since, there has been an increased understanding of the interrelationship between physical health and mental health. Missed Opportunities Primary care is an ideal setting for the identification of mental health problems and disorders, since the majority of people seek their mental health care in these settings. Primary mental health conditions -- depression, alcohol use, anxiety, sleep problems, chronic fatigue, and unexplained somatic symptoms -- are both prevalent and amenable to treatment in primary care, especially when they are identified early. However, they often go undetected or improperly treated. Estimates indicated that in the U.S., 58% of people with depression are not identified or adequately treated in health care settings. A recent study found a 17% prevalence of alcohol abuse or dependence, but only 5% of patients had ever had an alcohol abuse diagnosis in their medical record. Internationally, between 66% and 75% of people with a mental or substance abuse disorder do not report receiving treatment. Primary Mental Health The sheer numbers of people affected, the associated disability, and the fact that effective treatment is available further emphasizes the importance of addressing mental health problems and disorders in primary care. In a recent WHO study of seven countries, the 12-month prevalence of mental disorders varied widely with a high of 29% in the U.S. experiencing at least one mental disorder in a year compared to a low of 8% in Turkey. In spite of the fact that the prevalence of these disorders is often greater in primary care settings, these disorders often go undiagnosed and as a result less than 33% of those whom need treatment get it. If we look specifically at suicide the importance of identification in primary care is clear. After controlling for depression, alcohol abuse, and other factors, the presence of a general medical condition increases the likelihood of suicidal ideation, and the presence of cancer or asthma was associated with a 4-fold increased risk of a suicide attempt. In 1999, 19% of U.S. 9th-12th grade students reported seriously considering suicide. Given that 70% of U.S. adolescents see a primary care provider at least once a year, primary care providers are in a unique position to help prevent youth suicide. Older patients are more likely to have visited a primary care physician on the day of their suicide (20%), the week before (40%), or the month before (70%). Primary care settings can effectively treat many mental health problems and disorders. Studies have demonstrated that, by integrating mental health staff within a primary care setting, remission rates for depression can be produced comparable to those in specialty care studies. Research also suggests that brief interventions by primary care providers are effective in reducing problem drinking. Addressing mental health problems and disorders in primary care settings can help patients achieve "the complete state of physical, mental, and social well-being and not merely the absence of disease." Mind-Body Relationship Numerous studies demonstrate excess mortality, morbidity, and health care use for those with mental health and substance abuse disorders. The strongest predictors of general hospitalization and physician visits among patients with chronic medical illness are depression and psychological stress. Compared to non-depressed patients, depressed patients were three times more likely to be non-compliant with medical treatment recommendations. Persons with mental and substance abuse disorders are two times more likely to smoke and thus are at risk for the associated increased rate of heart disease, lung disease and cancers. (Information courtesy of the American Association of World Health) Return