To the Editor: The interaction between general medical care and specialist care plays a crucial role in redistribution of National Health Service resources. The Second School of Specialization in Psychiatry of La Sapienza University in Rome, Italy, worked with the department of mental health of the local health authority to develop a strategy of collaboration between general practitioners and the department of mental health.
The project was divided into three phases with three objectives: to become familiar with general practitioners and their therapeutic strategies for psychiatric illness, to improve the skill of general practitioners in identifying psychiatric illnesses, and to increase the level of collaboration between general practitioners and the department of mental health.
We report the results of the first phase, in which general practitioners were surveyed. Data were collected by a questionnaire soliciting single or multiple responses to 15 items. The items were divided into four sections: diagnosis, treatment, collaboration, and training. The questionnaire was mailed in November 1998 to 190 general practitioners in the northern zone of Rome province, extending from the coast to the hilly, rural internal region. The area's total population at the time was 243,822. The data obtained were submitted to statistical and descriptive analysis.
A total of 163 general practitioners (86 percent) completed and returned the questionnaire. Respondents were asked about the prevalence of psychiatric illnesses. Eighty-three (51 percent) estimated it to be less than 10 percent, 64 (39 percent) estimated it to be between 10 percent and 25 percent, and 16 (10 percent) said it was between 25 percent and 50 percent.
The disorders most frequently observed by general practitioners in their family practice were anxiety, reported by 57 respondents (35 percent), followed by psychosomatic disorders (33 respondents, or 20 percent), sleep disorders (29 respondents, or 18 percent), and mood disorders (24 respondents, or 15 percent). Fifty-one respondents (31 percent) stated that they would not have difficulty formulating a diagnosis of psychiatric illness. Forty-six (28 percent) responded that they would refer the patient to a specialist for diagnosis, and 42 (26 percent) felt that there was some confusion about the nosological terms currently used.
A total of 150 general practitioners (92 percent) thought that treatment of psychiatric disorders should be undertaken in collaboration with the mental health department; in fact, 129 (79 percent) had already had at least one contact with the department. Nevertheless, 160 (98 percent) said that they treated patients with psychiatric problems: 78 (48 percent) by administration of psychotropic drugs and 57 (35 percent) by combined treatment; 25 respondents (15 percent) said they adopted a psychological approach in which no psychotropic medications were prescribed.
Finally, when asked if they would like to be interviewed later for the ongoing study, 122 general practitioners (75 percent) replied positively.
The most significant findings to emerge were the marked level of interest in the study by general practitioners; 86 percent of those contacted agreed to take part—a response rate higher than those in other Italian studies (1,2). Another important finding was the underestimation of psychiatric disorders in general practice. The 1989 World Health Organization's multicenter study reported that the worldwide incidence of diagnosable psychiatric disorders was 24 percent (3). According to Fink and colleagues (4), the disorder most frequently unrecognized was somatization, which was not diagnosed by as many as 52 percent of the practitioners in the study.
Finally, a third important finding of the study was the level of desire expressed by general practitioners for closer collaboration with the regional psychiatric services.
The authors are affiliated with the department of psychiatric science and psychological medicine at La Sapienza University in Rome.