Because of the disability associated with depression and of its impact on health care utilization, guidelines and intervention strategies are needed.

The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.

In three general medical settings (general practice, hospital medical wards and emergency rooms) about 20% of the adult attenders had a DSM-III mental disorder, mainly in the area of affective and anxious disorders. Some of these disorders were quite severe. Of those cases reassessed 1 year and 2 years after the first interview, less than a quarter reached a "no-diagnosis status". The chronicity of most cases dependent on the interplay not only of either relapse or duration of the main disorder but also of comorbidity and incidence of new disorders. A high incidence of more transient disorders in subjects who were well at first assessment was also found.

Group training in problem-based interviewing utilizing video feedback is a robust, culturally transferrable model for improving the skills of established physicians. Our results suggest that training produces indirect effects that are the result of the teaching method rather than of explicit instructions. Further research is required to assess how to optimize the effect of educational interventions to ensure sustainability and maximal impact on measurable outcomes of care.

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