May 16, 1990


JAMA. 1990;263(19):2675-2677. doi:10.1001/jama.1990.03440190131071

The past decade has seen the continued growth of solid psychiatric epidemiologic studies that are relevant to disease prevalence, to disease varitions (patterns of symptoms and impairment encountered in the community), and to health care use. For the range of depressive and anxiety disorders, a small proportion of patients are seen in the specialty sector, far more in general medical settings, and a large proportion—even with the recent availability of an enlarged array of treatment options1—remain untreated. Evidence mounts for the increased medical morbidity and impairment of social performance and physical functions generated by these disorders. Continued research is needed to differentiate mood disorders and symptoms, a problem analogous to determining when a measurement of elevated blood pressure becomes a syndrome or disorder.

These issues are highlighted by the initial reports from the large Medical Outcomes Study conducted by The RAND Corporation. Tarlov and associates2 deliberately included