To the editors,

We read with interest the manuscript entitled Brazilian Multicentre Study of Common Mental Disorders in Primary Care: Rates and Related Social and Demographic Factors ¹1  Gonçalves DA, Mari JJ, Bower P, Gask L, Dowrick C, Tófoli LF, et al. Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors. Cad Saúde Pública 2014; 30:623-32. by Gonçalves et al. in Cadernos de Saúde Pública, in the March 2014 issue.

The term “common mental disorders” (CMD) may confuse non-psychiatrists, although it has been used extensively in the medical literature ²2  Goldberg DP, Huxley P. Common mental disorders: a bio-social model. London: Tavistock/Routledge; 1992.^,33  Fortes S, Villano LB, Lopes CS. Nosological profile and prevalence of common mental disorders of patients seen at the Family Health Program (FHP) units in Petropolis, Rio de Janeiro. Rev Bras Psiquiatr 2008; 30:32-7.. At a first glance, readers tend to think of CMD as a group of prevalent mental illnesses such as depression, anxiety, schizophrenia, bipolar disorder and obsessive compulsive disorder. There have been other articles ³3  Fortes S, Villano LB, Lopes CS. Nosological profile and prevalence of common mental disorders of patients seen at the Family Health Program (FHP) units in Petropolis, Rio de Janeiro. Rev Bras Psiquiatr 2008; 30:32-7.^,44  Borim FSA, Barros MBA, Botega NJ. Transtorno mental comum na população idosa: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29:1415-26. in the Cadernos de Saúde Pública in which the term CMD was used, and, as a periodical that is generally accessed by non-specialists in psychiatry, CMD should be written in a way that ensures that readers are aware of its real meaning: that is, a specific condition with symptoms in the depression-anxiety spectrum which does not fulfill criteria for these two diseases. It is not until “measures” in Gonçalves’s text that CMD is better explained.

Another point worth discussion is the exclusion of individuals with cognitive impairment. Over 75% of the elderly in Brazil receive health care exclusively from the Brazilian Unified National Health System (SUS). Brazilian authors have reported that cognitive impairment in elderly patients is not being assessed by “General Practitioners” from the SUS ⁵5  Jacinto AF, Brucki S, Porto CS, Martins MA, Nitrini R. Detection of cognitive impairment in the elderly by general internists in Brazil. Clinics 2011; 66:1379-84.. Certainly, Family Health Strategy settings attend a large number of elderly individuals.

The instruments used in the study (GHQ-12 and HAD) are not applicable to cognitively impaired individuals so it is reasonable that the authors excluded these patients. However there are studies that have shown a high prevalence of CMD among the elderly ⁴4  Borim FSA, Barros MBA, Botega NJ. Transtorno mental comum na população idosa: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saúde Pública 2013; 29:1415-26. in addition to a lack of interference of cognitive impairment in the GHQ-12 results ⁶6  Papassotiropoulos A, Heun R, Maier W. Age and cognitive impairment influence the performance of the General Health Questionnaire. Compr Psychiatry 1997; 38:335-40., although a different cut-off score was found to be more efficient in this case.

Some questions have emerged after reading Gonçalves’s study: “How were individuals with cognitive impairment diagnosed?”; “How large was the elderly population of the sample, since individuals aged 60 and above are classified as elderly in Brazil (there were patients from 60 to 65 years of age in the study)?”; “Why were cognitively unimpaired elders not included in the study?”

We are far from questioning the importance and reliability of Gonçalves’s text. Indeed, we thank the authors for bringing us such a rich material to be discussed further.

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