Commentary

Because up to a third of patients in primary care have psychological conditions requiring care,¹ the review of primary care counselling for psychological and psychosocial problems by Rowland et al is welcome. The review examined studies of counselling in primary care done by trained counsellors. On the surface, it seems that the use of counsellors in primary care is appropriate; however, there are a few caveats. Because the studies had differing inclusion criteria, data for patients with major depression, dysthymia, or anxiety disorders were pooled together in the analyses. In addition, the type of counselling varied from study to study. The review would have been strengthened if specific psychological symptoms had been analysed separately to determine whether certain ones are more amenable to counselling. The results may not apply to all psychological symptoms. Finally, because counselling was not compared with psychotropic drugs, it is unclear whether 5 minutes of counselling and the additional use of drugs would be as beneficial as the reliance on multiple sessions of counselling.

Even with these cautions, a counsellor in primary care practice seems to be beneficial and should be a service that is covered by health insurance. This review clearly shows that patients prefer counselling.