Objective - To investigate the form, frequency, management and outcome of common psychological disorders in primary care patients. Design - Two-stage sampling of primary care attenders followed by 3 and 12 month longitudinal assessment of mental state disability and treatment carried out using the same methods in 15 centres around the world, and coordinated by the World Health Organization. Main measures - The General Health Questionnaire, the primary care version of the Composite International Diagnostic Interview used to derive ICD-10 diagnosis, the Groningen Social Disability Schedule, and the primary care physician's assessment of the patient's current physical and psychological status along with a summary of their management of the case. Results - 25,916 patients were screened and 5,438 patients were interviewed in detail. Mental disorders among general health care attenders were common (average 24% of consecutive attenders, range 7.3%-52.5%). Disability was increased in patients with psychological illness: the more severe the psychological illness, the more severe was the disability The main presenting problem of such patients was often somatic, and only a minority presented a clearly psychological symptom. Detection varied greatly between centres, and across all centres half of the ICD-10 cases were not detected by the attending physician. Doctors in Verona displayed a particular bias towards psychological disorder. Treatment was offered to almost all patients identified as having psychological disorder by the primary care physician, though treatments showed a similar distribution regardless of diagnosis. Conclusions - The frequency and disability associated with the psychiatric disorder in general health care emphasise their importance to primary care and public health. These are patients who present to primary care, and most continue to be managed in primary care without recourse to specialist mental health services. It is important that training about the detection, diagnosis and management of common mental disorders are strengthened at medical school and in the vocational training of general practitioners.

Objective - The analysis aims to study trends, during the period of 1983-1993, of the most relevant variables concerning equipment, staff and activity of the Lombardy Region Psychiatric Services. Setting - The study used data from all services, both hospital and community, that depend on Psychiatric Units. Data regarding Psychiatric Hospitals were not included. Design - Data were provided by the Regional Psychiatric Information System, which since 1983 has regularly collected information on equipment, staff and services supplied by the Regional Psychiatric Unit. A graphic analysis with a description of trends and the interrelation of the time series has been carried out. Main outcome measures - The analysis uses two types of variables: resources and services variables related to other community psychiatric facilities. Indexes or rates are computed to study the relations between the two sets of variables. Results - We verified a remarkable upward trend in the level of activity (both hospital and community) not entirely explained by the increase in resources. In fact, the growth of psychiatric services is linked with higher productivity and a growing demand as well. We have also seen that the growth of community activity has been stronger than that concerning hospital variables. Thus, as far as we can assess from data (not including the private sector), the use of hospitalization in psychiatric activity has decreased in the last decade. Conclusions - The analysis highlights the importance of an Information System to describe changes in service organizations and to provide data for specific studies, such as outcome studies.

Objective - Epidemiology is in focus of attention these years. Psychiatry pioneered the development of epidemiological methods and their application in research and planning. Psychiatric epidemiology has been preoccupied with the secondary health service, i.e. the hospital-based service. The aim of the present paper is to discuss which monitoring systems and which types of data will be needed in the future. Method - The discussion is based on experience and results from existing psychiatric registers, mainly the Danish Psychiatric Case Register at the Department of Psychiatric Demography in Aarhus. Results - Some countries have developed monitoring systems to routinely record data on activities in the hospital sector, which is highly beneficial to quality assurance, research, and planning. However, after the introduction of decentralized psychiatry it is necessary to acknowledge the urgent need to move the focus for the employment of epidemiology to benefit also the activities in community psychiatry and in the primary mental health care sector. Though it involves great difficulties, monitoring systems to collect valid and reliable information from these systems of care must be developed. It is also necessary to develop epidemiological methods to be employed in research and quality assurance within this field. Such research methods should be used, not only in the exploration of the aetiology, course and clinical outcome of psychiatric disorders, but also when observing, for example, the social functioning and disability of psychiatric patients, the need for care, the meeting of needs, the health economy and patient flow between the different levels of the system of treatment. This results in large demands on data security, legislation and ethics for the collection and employment of data in the epidemio-logical models. Conclusion - It is recommended to give priority to extended utilization of existing register data; establishment of secondary mental health care registers in countries without such facilities; establishment of primary mental health care registers; establishment of disability monitoring systems; establishment of systems to monitor patients' resources; extended collaboration in this work between psychiatric epidemiologists, administrators, economists, and technicians.