Secular trends in primary care utilisation for mental health problems: a Norwegian register-based population-wide study

BACKGROUND: Evidence from several countries suggests increasing mental health problems among children and adolescents, raising concerns about deteriorating population mental health. Whether rising consultation rates reflect worsening morbidity or changes in help-seeking remains unclear. We aimed to describe secular trends in mental health consultations in Norway and compare trends for symptom-coded versus disorder-coded anxiety and depression. METHODS: We conducted a nationwide repeated cross-sectional study of all individuals aged 10-46 years in Norway during 2010-2024 (N=3 728 002). Using linked administrative registers of general practitioner contacts, we estimated annual sex- and age-specific prevalence of any mental health consultation (International Classification of Primary Care (ICPC-2) P codes), distinguishing anxiety/depression symptoms (P01, P03) from disorders (P74, P76). Quasibinomial regression estimated annual prevalence ratios (PRs) and post-2020 changes. RESULTS: From 2010 to 2024, the prevalence of mental health diagnoses increased by 62% (9.9% to 16.0%), rising 66% for girls/women (11.8% to 19.6%) and 54% for boys/men (8.2% to 12.6%). Shares of anxiety-symptom consultations increased from 0.44% to 1.7%, while anxiety disorder consultations rose modestly (0.95% to 1.4%). Shares of depressive symptom consultations increased from 0.73% to 1.8%, whereas depressive disorder consultations were stable (2.8% to 2.7%). Annual PRs were consistently higher for symptom than disorder codes, and after 2020 depressive symptom prevalence accelerated among adults aged 21-30. CONCLUSION: The prevalence of mental health problems increased substantially from 2010 to 2024, driven primarily by symptom-coded consultations. These patterns suggest lowered help-seeking thresholds and/or changes in coding, although changes in underlying distress cannot be excluded. The findings have implications for practitioners and policymakers planning resource allocation.