One hundred twenty patients from each of 6 family practices were surveyed to determine the prevalence of symptom-based psychiatric illness (emotional distress) in family practice. Assessments of presence or absence of emotional distress and the severity of this distress were made using ratings made by the treating physician and by the patient. Nineteen percent of the surveyed patients were designated by their physicians as having "high distress," and 21% by the patient-completed abbreviated Hopkins Symptom Checklist (HSCL-25). High concordance (86.7%) existed between the "case" assessment by the physician and the patient's own rating of distress. For the majority of "high distress" patients, pharmacotherapy was considered the treatment of choice by physicians.