Cited by 352Mental Health Treatment and AccessPrimary Care and Health OutcomesAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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High prevalence of mental disorders in primary care

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Ansseau, M., Dierick, M., Buntinkx, F., Cnockaert, P., De Smedt, J., Van Den Haute, M., Vander Mijnsbrugge, D.·2004·Journal of Affective Disorders

DOI 10.1016/s0165-0327(02)00219-7

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Abstract

Objective To determine the prevalence of common mental disorders in an adult primary care population.Design Cross-sectional survey in randomly selected subjects, using the PRIME-MD questionnaire.Setting Eighty-six general practices in Belgium.Subjects A total of 2316 randomly selected patients, aged 18 years or older and consulting their general practitioner for other than administrative reasons alone, with slightly more women (58.1%) than men (41.3%). MAIN OUTCOME RESULT: Prevalence rates of mental disorders most commonly seen in primary care practice (mood, anxiety, somatoform, eating and alcohol disorders).Methods To facilitate data collection and processing, the entire PRIME-MD questionnaire was programmed on a handheld computer. Patient answers and physician assessments were immediately electronically recorded during the interview. All investigators were trained on the use of the PRIME-MD. The recruitment period lasted 6 weeks: from 15 February to 25 March 1999, and patients were randomly selected for the interview based on a computerized procedure.Results Although only 5.4% of all patients consulted for a psychiatric reason, a threshold/subthreshold psychiatric disorder was detected in 42.5% of all patients. Most commonly detected disorders were mood disorders in 31.0% (major depressive disorder, 13.9% and dysthymia, 12.6%), anxiety disorders in 19.0% (generalized anxiety disorder, 10.3%), somatoform disorders in 18.0% and probable alcohol abuse/dependence in 10.1%. The results also showed the important rate of comorbidity between these disorders.Conclusion The present study confirms the high prevalence of mental disorders in a general practice setting, and their frequent association. Prevalence rates of our study are even higher than those obtained in previously conducted trials. Our study also demonstrates the utility of the PRIME-MD as a screening tool for mental disorders in primary care. In addition the use of the handheld computer software version of the PRIME-MD allowed us to screen for mental disorders in patients who are unable to attend the GP office and are seen during 'home' visits.

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Validation and Utility of a Self-report Version of PRIME-MD<SUBTITLE>The PHQ Primary Care Study</SUBTITLE>
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Kathol, R. G., Saravay, S. M., Lobo, A., & Ormel, J. (2006) · Medical Clinics of North America · doi:10.1016/j.mcna.2006.04.002 · Cited by 61
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Teunissen, E., Sherally, J., van den Muijsenbergh, M. E. T. C., Dowrick, C. F., van Weel-Baumgarten, E. M., & van Weel, C. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005738 · Cited by 58
“Nevertheless, a large number of native patients diagnosed with mental disorders did not present their mental health problems to a GP either.(29) All UMs interviewed used religion and religious rituals as important positive coping mechanisms to deal with mental distress.”
Background
Dietary intake of branched-chain amino acids in relation to depression, anxiety and psychological distress
Koochakpoor, G., Salari-Moghaddam, A., Keshteli, A. H., Afshar, H., Esmaillzadeh, A., & Adibi, P. (2021) · Nutrition Journal · doi:10.1186/s12937-021-00670-z · Cited by 57
“High prevalence of psychological disorders, both in developed and developing countries, imposes heavy social and economic burdens on health care systems [3].”
Background
Prevalence and Associated Factors of Common Mental Disorders in Women: A Systematic Review
Bezerra, H. D. S., Alves, R. M., Nunes, A. D. D., & Barbosa, I. R. (2021) · Public health reviews · doi:10.3389/phrs.2021.1604234 · Cited by 58
“The Patient Health Questionnaire-9 (PHQ-9) was created from the PRIME-MD, and it is a more synthesized version, of easier application in adults [43].”
BackgroundMethodInfluential
Gender differences in clinical presentation and response to sertraline treatment of generalized anxiety disorder
Steiner, M. S., Allgulander, C., Ravindran, A. V., Kosar, H., Burt, T., & Austin, C. (2004) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.648 · Cited by 59
“, 2002) and current prevalence rates from 5% to 10% have been reported in primary care settings (Ansseau et al., 2004; Ormel et al., 1994; Wittchen et al., 2001).”
Background
Prévalence des troubles psychiatriques en médecine générale selon le patient health questionnaire : adéquation avec la détection par le médecin et le traitement prescrit
Norton, J. L., de Roquefeuil, G., David, M., Boulenger, J.-P., Ritchie, K. A., & MANN, A. H. (2009) · L Encéphale · doi:10.1016/j.encep.2008.06.018 · Cited by 54
The State of the Evidence for Integrated Behavioral Health in Primary Care
Kwan, B. M., & Nease, D. E. (2013) · Springer eBooks · doi:10.1007/978-1-4614-6889-9_5 · Cited by 55
“A broader focus on general mental health across a range of mental health needs, including basic psychosocial needs, health behavior modifi cation, and the myriad mental health conditions presenting in primary care (Ansseau et al., 2004 ), is much less common in the research literature.”
Background
Digital IAPT: the effectiveness & cost-effectiveness of internet-delivered interventions for depression and anxiety disorders in the Improving Access to Psychological Therapies programme: study protocol for a randomised control trial
Richards, D., Duffy, D., Blackburn, B., Earley, C., Enrique, A., Palacios, J., Franklin, M., Clarke, G., Sollesse, S., Connell, S., et al. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1639-5 · Cited by 52
“Psychiatric disorders are seldom the principal reason for GP visits, and yet in one primary care study, depression was encountered in upwards of 31% of consultations, with anxiety detected in approximately 19% of consultations [16].”
Background
A Bird's-Eye View of Exercise Intervention in Treating Depression Among Teenagers in the Last 20 Years: A Bibliometric Study and Visualization Analysis
You, Y., Wang, D., Wang, Y., Li, Z., & Ma, X. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.661108 · Cited by 54
Individual and joint associations of anxiety disorder and depression with cardiovascular disease: A UK Biobank prospective cohort study
Nakada, S., Ho, F. K. W., Celis-Morales, C. A., Jackson, C., & Pell, J. P. (2023) · European Psychiatry · doi:10.1192/j.eurpsy.2023.2425 · Cited by 50
“First, ascertainment of anxiety disorder and depression using hospital admission may be incomplete and less likely to include people with less severe conditions since they are often treated in primary care settings [27].”
Background
Efficacy of Combined Pharmacotherapy and Psychotherapy Versus Monotherapy in the Treatment of Anxiety Disorders
Black, D. W. (2006) · CNS Spectrums · doi:10.1017/s1092852900025827 · Cited by 48
Personal health record reach in the Veterans Health Administration: a cross-sectional analysis
Shimada, S. L., Brandt, C. A., Feng, H., McInnes, D. K., Rao, S. R., Rothendler, J. A., Haggstrom, D. A., Abel, E. A., Cioffari, L. S., & Houston, T. K. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3751 · Cited by 48
“Depression, anxiety, and PTSD are prevalent in the general patient population as well as in VA [28,30-37].”
Background
Anxiety and Quality of Life in ESRD
Cukor, D., Halen, N. V., & Fruchter, Y. (2013) · Seminars in Dialysis · doi:10.1111/sdi.12065 · Cited by 48
“A different study reported a 30% prevalence of anxiety disorders in HD patients using the Primary Care Evaluation of Mental Disorders (PRIME-MD), which indicated a 19% prevalence of anxiety disorders in 2316 general medical patients (11,12).”
Prevalence and correlates of depression and alcohol use disorder among adults attending primary health care services in Nepal: a cross sectional study
Luitel, N. P., Baron, E. C., Kohrt, B. A., Komproe, I. H., & Jordans, M. J. D. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3034-9 · Cited by 36
“The prevalence of mental disorders can be even higher among people attending primary health care facilities [18, 19]; however, a large variation has * Correspondence: luitelnp@gmail.”
Background
Pharmacotherapy of generalized anxiety disorder: results of duloxetine treatment from a pooled analysis of three clinical trials
Allgulander, C., Hartford, J. T., Russell, J. D., Ball, S. G., Erickson, J., Raskin, J., & Rynn, M. A. (2007) · Current Medical Research and Opinion · doi:10.1185/030079907x182202 · Cited by 47
The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population
Tarleton, E. K., Kennedy, A. G., Rose, G. L., Crocker, A., & Littenberg, B. (2019) · Nutrients · doi:10.3390/nu11071475 · Cited by 45
“The lifetime prevalence of a mood disorder is almost 30% in primary care populations [4,5] and patients are more likely to receive treatment from their primary care providers than from mental health professionals [5,6].”
Background
Psychological interventions for anxiety in adult primary care patients: a review and recommendations for future research
Shepardson, R. L., Buchholz, L. J., Weisberg, R. B., & Funderburk, J. S. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.12.004 · Cited by 44
“Introduction Anxiety is one of the most frequent mental health concerns in primary care, with prevalence rates of 15 to 20% for any current anxiety disorder (Ansseau et al., 2004; Kroenke, Spitzer, Williams, Monahan, & Löwe, 2007).”
Prevention of anxiety and depression in Chinese: A randomized clinical trial testing the effectiveness of a stepped care program in primary care
Zhang, D., Lewis, G., Araya, R., Tang, W. K., Mak, W. W. S., Cheung, F. M., Mercer, S. W., Griffiths, S. M., Woo, J., Lee, D., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.08.015 · Cited by 44
“Subthreshold depressive and anxiety symptoms are prevalent in primary care (Ansseau et al., 2004; Blazer et al., 1988; Nisenson et al., 1998; Pini et al., 1997) and evidence shows that up to 35% of these patients developed a major depressive or anxiety disorder within one year (Beekman et al.”
Background
The development and validation of Huaxi emotional-distress index (HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings
Wang, J., Guo, W., Zhang, L., Deng, W., Wang, H.-Y., Yu, J., Luo, S., Huang, M., Dong, Z., Li, D., et al. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.04.001 · Cited by 43
“[49] Ansseau M, Dierick M, Buntinkx F, Cnockaert P, De Smedt J, Van Den Haute M, et al.”
Background
Identified mental disorders in older adults in primary care: A cross-sectional database study
McCombe, G., Fogarty, F., Swan, D., Hannigan, A., Fealy, G., Kyne, L., Meagher, D. J., & Cullen, W. (2018) · European Journal of General Practice · doi:10.1080/13814788.2017.1402884 · Cited by 43
“Internationally, much of the research to date has focussed on measuring prevalence of mental disorders in primary care through face-to-face evaluations using structured clinical interviews [18], PRIME-MD questionnaire [19], and questionnaires [20] There is little consensus on the overall prevalence of mental disorders…”
Background
Clinical decisions and stigmatizing attitudes towards mental health problems in primary care physicians from Latin American countries
Vistorte, A. O. R., Ribeiro, W. S., Ziebold, C., Asevedo, E. D. M., Evans-Lacko, S. E., Keeley, J. W., Gonçalves, D. A., Palacios, N. G., & Mari, J. D. J. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206440 · Cited by 43
“(2004) in a survey performed in Belgium found that, in the year prior to the study, 31% of adult patients in primary care services had affective disorders, 19% had some type of anxiety disorder, 18% had some type of somatoform disorder and 10% had disorders related to use of alcohol, and other studies estimate that 24…”
Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care
Cwikel, J., Zilber, N., Feinson, M., & Lerner, Y. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-007-0286-9 · Cited by 61
“Using the PRIME-MD, prevalence estimates for psychiatric disorders range from 26% to 60% [3, 4, 15, 28, 33].”
Method
Generalized anxiety disorder and health care use.
Bélanger, L., Ladouceur, R., & Morin, C. M. (2005) · PubMed Central · Cited by 42
Quality of life, self-stigma, and coping strategies in patients with neurotic spectrum disorders: a cross-sectional study
Holubova, M., Prasko, J., Ociskova, M., Kantor, K., Vanek, J., Slepecky, M., & Vrbova, K. (2019) · Psychology Research and Behavior Management · doi:10.2147/prbm.s179838 · Cited by 41
“5,6 Also, clinical practice advocates that anxiety symptoms are negatively related to QoL.”
Impact of Comorbidity and Socioeconomic Status on Quality of Life in Patients with Chronic Diseases who Attend Primary Health Care Centres
Tüzün, H., Ayçan, S., & ILHAN, M. N. (2015) · Central European Journal of Public Health · doi:10.21101/cejph.a3990 · Cited by 40
“However, it was necessary to use an alternative source since the records of chronic diseases registered at PHCs were insufficient.”
BackgroundInfluential
Anxiety and depression in primary care patients: Predictors of symptom severity and developmental correlates
Runkewitz, K., Kirchmann, H. A., & Strauss, B. M. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.09.003 · Cited by 39
“Ansseau [5], for example, found a prevalence rate for anxiety symptoms of 19.”
Background
The Role of Pain-Related Cognitions in the Relationship Between Pain Severity, Depression, and Pain Interference in a Sample of Primary Care Patients with Both Chronic Pain and Depression
Sánchez-Rodríguez, E., Aragonès, E., Jensen, M. P., Tomé-Pires, C., Rambla, C., López-Cortacans, G., & Miró, J. (2020) · Pain Medicine · doi:10.1093/pm/pnz363 · Cited by 38
What is integrated care?
Huang, H., Meller, W. H., Kishi, Y., & Kathol, R. G. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.964189 · Cited by 43
“In the medical setting there are many more medical patients with BH co-morbidity (40% of medical outpatients (Ansseau et al., 2004; Rivelli & Shirley, 2014) and 30% of medical inpatients (Kathol et al., 2014b)) than BH specialists to assess and treat them.”
Background
Prevalence of psychiatric morbidity in the primary health clinic attendees in Kuwait
AlKhadhari, S., Alsabbrri, A. O., Mohammad, I., Atwan, A. A., Alqudaihi, F., & Zahid, M. A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.01.037 · Cited by 38
“The 42.3% point prevalence of psychiatric disorders in our sample is relatively higher than that reported by the recent three large recent epidemiological studies using the PHQ (Spitzer et al., 1999; Ansseau et al., 2004; Roca et al., 2009).”
Influential
Transtornos mentais em uma amostra de gestantes da rede de atenção básica de saúde no Sul do Brasil
de Almeida, M. S., Nunes, M. A., Camey, S. A., Pinheiro, A. P., & Schmidt, M. I. (2012) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2012000200017 · Cited by 40
Use of the PRIME-MD Patient Health Questionnaire for estimating the prevalence of psychiatric disorders in French primary care: comparison with family practitioner estimates and relationship to psychotropic medication use
Norton, J. L., de Roquefeuil, G., Boulenger, J., Ritchie, K. A., MANN, A. H., & Tylee, A. T. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.02.005 · Cited by 38
“The PRIME-MD has been used in a study on 86 family practices throughout Belgium [20].”
MethodInfluential
Factors affecting the presence of depression, anxiety disorders, and suicidal ideation in patients attending primary health care service in Lithuania
Bunevičius, R., Liaugaudaitė, V., Pečeliūnienė, J., Raškauskienė, N., Bunevičius, A., & Mickuvienė, N. (2014) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2013.873604 · Cited by 37
“Depression and anxiety disorders are highly prevalent in the primary care (PC) patient population and are associated with increased risk for medical illness and with decreased level of functioning [1].”
Background
Clinical differences between first and recurrent episodes in depressive patients
Roca, M., Armengol, S., García-García, M., Rodríguez-Bayón, A., Ballesta, I., Serrano-Ripoll, M. J., Comas, À., & Gili, M. (2010) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2010.04.011 · Cited by 40
“Prevalence ranges from 6% to 20% [1-5].”
Ruhsal Bozuklukların Yaygınlığı, Cinsiyetlere Göre Dağılımı ve Psikiyatrik Destek Alma ile İlişkisi
Keskin, A., Ünlüoğlu, İ., Bilge, U., & Yenilmez, Ç. (2013) · Nöro Psikiyatri Arşivi · doi:10.4274/npa.y6522 · Cited by 37
“The fact that the scale we used considered subthreshold symptoms as diagnostic might be effective in these slightly high rates (3,27).”
BackgroundResultInfluential
Validation of a brief PTSD screener for underserved patients in federally qualified health centers
Han, B., Wong, E. C., Mao, Z., Meredith, L. S., Cassells, A. N., & Tobin, J. N. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.07.009 · Cited by 37
“FQHCs are in a prime position to facilitate access to needed mental health treatment given the high prevalence of psychiatric disorders in primary care settings (Ansseau et al., 2004; Sansone & Sansone, 2010).”
Background
Generalized Anxiety Disorder
Adrian Wells, A. (2006) · Springer eBooks · doi:10.1007/0-306-48581-8_56 · Cited by 37
Pros and Cons of Physician Aid in Dying.
Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019) · Europe PMC (PubMed Central) · Cited by 36
The Impact of Anxiety, Depression, and Suicidality on Quality of Life and Functional Status of Patients With Congestive Heart Failure and Hypertension
Serafini, G., Pompili, M., Innamorati, M., Iacorossi, G., Cuomo, I., Vista, M. D., Lester, D., Biase, L. D., Girardi, P., & Tatarelli, R. (2010) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.09m00916gry · Cited by 36
Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry
Lowenstein, M., Bamgbose, O., Gleason, N., & Feldman, M. D. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7921 · Cited by 35
“Primary care providers (PCPs) play an increasingly large role in diagnosis and management, in part, because of limited access to mental health specialty care [3-6].”
Validation of the Opening Minds Scale and patterns of stigma in Chilean primary health care
Sapag, J. C., Klabunde, R., Villarroel, L. A., Velasco, P. R., Huenchulaf, C. Á., Parra, C., Bobbili, S. J., Mascayano, F., Bustamante, I. V., Alvarado, R., et al. (2019) · PLoS ONE · doi:10.1371/journal.pone.0221825 · Cited by 36
Prevalência de transtornos mentais em indivíduos de uma unidade de referência para Programa Saúde da Família em Santa Cruz do Sul, Rio Grande do Sul, Brasil
Gonçalves, D. M., & Kapczinski, F. P. (2008) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2008000900010 · Cited by 39
Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients
Hennemann, S., Kuhn, S., Witthöft, M., & Jungmann, S. M. (2022) · JMIR Mental Health · doi:10.2196/32832 · Cited by 31
“However, the most common mental disorders were frequent in our sample and resembled prevalence rates in medical settings [70].”
Background
Longitudinal change instead of baseline testosterone predicts depressive symptoms
Kische, H., Pieper, L., Venz, J., Klotsche, J., März, W., Koch, U., Pittrow, D. B., Lehnert, H., Silber, S., Stalla, G. K., et al. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.12.013 · Cited by 34
“, 2017), but this evidence itself is limited to findings from cross-sectional studies Given our DSQ-based assessment of depressive episodes, we estimated two-week-point prevalence estimates, which are lower than generally reported prevalence estimates of depressive episodes among primary care patients (Ansseau et al.,…”
Background
Variables associated with general practitioners taking on serious mental disorder patients
Fleury, M., Bamvita, J., & Tremblay, J. (2009) · BMC Family Practice · doi:10.1186/1471-2296-10-41 · Cited by 34
“plex forms of mental disorders, particularly major depression with suicidal tendencies, schizophrenia, and bipolar disorders [28,40,41].”
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Exploring the structure of the GAD‐7 scale in primary care patients with emotional disorders: A network analysis approach
Moriana, J. A., Jurado-González, F. J., García‐Torres, F., Contreras, A., Muñoz‐Navarro, R., González‐Blanch, C., Medrano, L. A., Ruiz‐Rodríguez, P., & Vindel, A. C. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23217 · Cited by 34
How common is bipolar disorder in general primary care attendees? A systematic review and meta-analysis investigating prevalence determined according to structured clinical assessments
Stubbs, B., Vancampfort, D., Solmi, M., Veronese, N., & Fornaro, M. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415623857 · Cited by 32
“Six studies were conducted in Europe (Ansseau et al., 2004; Kroon et al., 2013; Serrano-Blanco, 2010; Sorvaniemi and Salokangas, 2005; Szádóczky et al., 1997, 2004) and five Australian & New Zealand Journal of Psychiatry, 50(7) were conducted in North America (Gaynes et al., 2010; Olfson et al.,…”
BackgroundInfluential

Authors: Ansseau, M., Dierick, M., Buntinkx, F., Cnockaert, P., De Smedt, J., Van Den Haute, M., & Vander Mijnsbrugge, D.
Affiliations: University of Liège (BE)
Ghent University (BE)
Université Libre de Bruxelles (BE)
Corresponding author: Ansseau, M.
ORCID: Dierick, M.
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2004-01
Volume: 78
Issue: 1
Pages: 49-55
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/s0165-0327(02)00219-7
OpenAlex: W2156494550
Cited by: 352
References: 13
Citations by year: 2026: 3 · 2025: 3 · 2024: 10 · 2023: 8 · 2022: 16 · 2021: 17 · 2020: 19 · 2019: 18 · 2018: 25 · 2017: 23 · 2016: 14 · 2015: 21 · 2014: 25 · 2013: 19 · 2012: 18
FWCI: 6.52
Type: journal article
Language: en
Open access: green
orbi.uliege.be
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
ORBi (University of Liège) (submittedVersion, other-oa)
DIAL (Catholic University of Leuven) (submittedVersion)
Revista cubana de medicina general integral
Funders: Pfizer
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: mental illness, prevalence, primary care, mood disorders, major depressive disorder, dysthymia, anxiety disorders, generalized anxiety disorder, somatoform disorders, eating disorders, alcohol abuse, alcoholism, comorbidities, mental disorder screening, personal digital assistants, home visits
MeSH terms: Adult, Aged, Mental Disorders, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Primary Health Care, Surveys and Questionnaires, Prevalence

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