In recent years the advent of standardized psychiatric research interviews and operational criteria for psychiatric diagnoses has been accompanied by a flurry of scientific papers reporting the prevalence of mental disorders among patients receiving care from general practitioners, internists, and surgeons. It has become clear that mental disorders are not only very much more common in health care settings than in random samples of the population but also that they are frequently unrecognized by medical professionals.

Prevalence and recognition of mental disorders among medical and surgical inpatients

The past 25 years have seen the appearance of numerous surveys of the mental health of patients in the medical and surgical wards of general hospitals. Lipowski reviewed ten studies and found that the average number of such patients with a mental disorder constituted 49% (SD, 23.1). Since the time of his study (1967), operational definitions of mental illness have become available for research use, and these have resulted in somewhat lower figures. Nevertheless, most recent surveys confirm that between one-fourth and one-third of patients on medical and surgical wards have diagnosable mental illnesses and that a substantial proportion of such illnesses are not detected by medical staff.

Schwab and co-workers, using the Beck Depression Inventory and the Hamilton Rating Scale for depression on a sample of 153 patients on various medical wards in Florida, found that between 22% and 23% of the patients were depressed.