Psychiatric diagnoses of medical service users: Evidence from the Epidemiologic Catchment Area Program

Based on data from the five sites of the National Institute of Mental Health-sponsored Epidemiological Catchment Area (ECA) Program, this paper examines the prevalence of psychiatric disorder among recent medical service users versus non-users, with a particular focus on affective disorders, substance abuse/dependence, and phobias. The rate of current Diagnostic Interview Schedule (DIS) disorders among medical users in all five ECA sites is 21.7 percent (slightly higher than general population rates) versus 16.7 percent among nonusers; there is generally no difference between users and nonusers with past DIS diagnoses. Affective disorders were among the most common mental disorders of medical service users, especially among females, with little variation between sites: females: users: 6.9 percent to 9.3 percent, nonusers: 3.4 percent to 6.4 percent, and males: users: 3.3 percent to 6.5 percent, nonusers: 1.2 percent to 4.1 percent. Rates of phobias among persons using medical services are also higher than among nonusers. Substance abuse disorders are at least as common among persons who use medical services (8 percent to 14 percent of male users) as among those who do not (9 percent to 11 percent of male nonusers). The high rates of affective disorders among women and of substance abuse among male medical service users underscore the need to increase the ability of general medical practitioners to recognize and manage or refer these conditions.