ABSTRACT
Over 20 years ago, Goldberg and Huxley [1] described a model for the distribution of common mental disorders in the population. This model describes distinct levels of attention or care for depressive or anxiety disorders: those receiving no health services, those seen in primary care but not recognized, those recognized and treated in primary care, those seen in specialty care, and those seen in hospitals. These levels of care are separated by a series of ‘‘filters’’ which govern passage from one level to the next. For example, the first filter governs how and when a person with symptoms of depression or anxiety might appear in the primary care clinic, whereas the second filter governs how andwhy those symptomsmight be recognized and treated by the primary care physician. In an ideal world, passage through these filters would depend solely on clinical need: For example, all patients with clinically
significant symptoms would be recognized and treated, and all patients with persistent symptoms following initial primary care treatment would be referred to specialty care. Unfortunately, the level or intensity of treatment for depression is often strongly influenced by factors other than clinical need. Recognition of depression, initiation of treatment, or referral to specialty care may depend primarily on nonclinical factors (stigma, race, education, availability of insurance coverage) and those with greatest clinical need may go unrecognized or untreated.
