Cognitive behaviour therapy in primary care

Mental health problems are one of the most frequent presentations in primary care in the UK and elsewhere: a World Health Organization 15-nation study identified that nearly a quarter of primary care attenders worldwide suffer from a psychiatric disorder (Sartorius et al 1996). The most common problems are depression and anxiety disorders. People with physical health problems, especially disabling conditions, are particularly at risk of these mental disorders (Prince et al 1998). Anxiety and depression are major sources of disability and suffering. Depression alone accounts for more disability than any other mental illness - almost 12 per cent of total years lived with disability worldwide (Ustun et al 2004) and more than diabetes, hypertension or chronic lung disease (Panzarino 1998). These problems are often seen as part of a more complex presentation. Depression and anxiety frequently co-exist with conditions such as cardiovascular disease, stroke, diabetes, chronic pain and hypertension. Course and prognosis of these physical illnesses is seriously worsened by comorbid mental disorder.