Primary care physicians (PCPs) are crucial in healthcare systems, providing treatment for various conditions, preventive care, and referrals. While many PCPs feel inadequately equipped to handle mental health issues, they are often the first point of contact for mental healthcare navigation. Efforts to enhance primary care focus on integrating mental health into whole-person care. To inform medical education and healthcare delivery, understanding the volume and types of mental health conditions managed by PCPs is vital. Existing data, such as reports from the American Psychological Association (70% of visits driven by psychological problems) and UK charity Mind (40% of appointments involve mental health), are often confusing and based on limitations like low response rates, short observation periods, and age restrictions. This study utilizes a unique data source – nationwide primary care records from Norway – to provide a comprehensive and unbiased account of the volume of mental health conditions addressed in primary care settings. The analysis covers 14 years of data (2006–2019), allowing for an assessment of the proportion of PCPs' work dedicated to mental health, the volume of different mental health conditions managed, and a comparison with other medical conditions.

Existing literature on the prevalence of mental health conditions in primary care settings presents a fragmented and sometimes contradictory picture. Reports from the American Psychological Association and the UK charity Mind offer estimates that vary significantly, highlighting the need for more robust and comprehensive data. Data from the National Ambulatory Medical Care Surveys, while providing some insights, suffer from limitations such as variable response rates, short reporting periods, and age restrictions. This study aimed to overcome these limitations by utilizing a comprehensive nationwide dataset.

This population-based study included 4,875,722 individuals (2,433,975 males; 2,441,247 females) residing in Norway between 2006 and 2019. Data were extracted from Norway's nationwide administrative primary-care records, covering all doctor-patient encounters. Encounters were coded using the International Classification of Primary Care (ICPC-2), categorizing conditions into 17 chapters representing different body systems. The study analyzed data at both the patient and encounter levels. Patient-level analysis determined the proportion of patients presenting with mental health conditions. Encounter-level analysis focused on the proportion of encounters dedicated to mental health conditions and compared this with encounters for conditions in other body systems. Mental health conditions were grouped into 24 categories based on ICPC-2 chapter P. Comparisons were made with 15 other ICPC-2 chapters representing other body systems, and with infections, pain, and injuries. Descriptive statistics were reported, with inferential statistics omitted due to the large sample size. Ethical approval was obtained from relevant committees in Norway and the USA.

The study found that nearly half (47%, N = 2,309,787) of the patients registered with a PCP between 2006 and 2019 presented for a mental health condition. These patients exhibited a wide range of psychological difficulties, from depression to irritability. Children most often presented with sleep disturbances, continence issues, and ADHD, while young and middle-aged adults presented with depression, and older adults with memory difficulties and sleep disturbances. At the encounter level, 11.7% (n = 41,616,704) of all primary care encounters involved a mental health condition. Depression (23.8%) and anxiety (14.1%) were the most common reasons, followed by sleep disturbances (12.1%), substance abuse (8.3%), and other conditions. Mental health encounters occurred across all age groups. The volume of mental health encounters was comparable to cardiovascular and respiratory conditions and exceeded encounters for all other body systems except musculoskeletal. The proportion of encounters involving mental health conditions showed a slight increase over the study period (11.0% in 2006 to 12.8% in 2019), although this increase could not be attributed to the COVID-19 pandemic.

The findings demonstrate a substantial and diverse volume of mental health conditions managed by PCPs in Norway, exceeding what may have been previously appreciated. The high prevalence across all age groups emphasizes the significant role of PCPs in providing mental healthcare. This challenges the notion that mental health is solely the purview of specialist services. The high volume of encounters for mental health underscores several crucial implications: the need for improved PCP training in mental health, the integration of mental health services into primary care settings, and the importance of addressing workforce capacity challenges. The limitations of this study necessitate caution against generalizing findings directly to other healthcare systems.

This study provides compelling evidence of the high prevalence and diversity of mental health conditions managed within primary care settings in Norway. The large volume of encounters dedicated to mental health conditions highlights the critical need for enhanced physician training in mental health, strengthened integration of mental health services into primary care, and strategic workforce planning. Future research should explore the effectiveness of different interventions and strategies to improve mental healthcare access and outcomes within primary care settings, with consideration for adapting findings to varied contexts.

The study's generalizability outside Norway may be limited by differences in healthcare systems and socioeconomic factors. The ICPC-2 codes capture reasons for seeking care, not population prevalence rates of mental health conditions. Treatment information was not available, preventing evaluation of the quality of care provided for mental health conditions. The study period ended in 2019, precluding a direct assessment of the impact of the COVID-19 pandemic on mental health encounters.