We read with great interest the recent study by Beck et al titled ‘Secular trends in primary care utilisation for mental health problems: a Norwegian register-based population-wide study’.
The authors interpret this divergence as being consistent with lower help-seeking thresholds and/or changes in coding practices. However, this interpretation relies on the assumption that symptom codes consistently represent lower clinical severity, an assumption that was not empirically evaluated. Furthermore, the repeated cross-sectional design cannot determine whether individuals initially assigned symptom codes subsequently progressed to anxiety or depressive disorder diagnoses. Consequently, the observed increase…