Screening for Depression in Primary Care: Can It Become More Efficient?

2009 ◽  
Author(s):  
Kathryn M. Magruder ◽  
Derik E. Yeager
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Care Providers ◽  
First Line ◽  
Preventive Mental Health ◽  
Recommended Services

Screening for depression has been so widely advocated that the burden of proof has shifted to skeptics who argue against it. Yet only recently has sufficient evidence accrued to judge dispassionately the advantages and disadvantages of screening. Here we discuss the evidence for specific tools and specific strategies in improving the outcome of depression screening in primary care. In 1978, the Institute of Medicine defined primary care as ‘‘care that is accessible, comprehensive, coordinated, continuous, and accountable.’’ While the definition has evolved over time,2 these fundamental characteristics are still valid today. Included in the primary care mission is to serve as the first line for detection and either treatment or referral of common mental disorders, including depression. The inclusion of first-line mental health services as a component of primary care distinguishes primary care (including outpatient clinics in managed care organizations, community hospitals, Veterans Administration hospitals, teaching institutions, and other medical centers) from care in more specialized clinical settings. The comprehensiveness of primary care and the obligation of its providers for first-line care make it a logical and appropriate venue for mental health screening. Complicating the issue, however, are the time constraints on primary care providers. Although the amount of time spent per patient visit is about 20 minutes in the United States, the recommended services that should be provided in that short period of time are daunting. It is therefore imperative that these recommended services—in particular preventive health services— be provided in the most efficient manner possible. Services that cannot be provided efficiently and fit within the busy, fast-paced world of primary care are at risk of being omitted. This is especially true for preventive mental health services. Screening for depression is such a service; therefore, it is critical that primary care providers make use of the best and most efficient depression screening approaches possible. In this chapter, we will address issues related to screening for depression in the primary care context. We will start by briefly reviewing the epidemiology of depression as related to primary care. Next, we will provide a critical examination of the applicability to depression screening of the World Health Organization’s criteria.

The Bridge Program: A Model for Delivering Mental Health Services to Asian Americans through Primary Care

2005 ◽  
Vol 3 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Hongtu Chen ◽  
Elizabeth Kramer ◽  
Teddy Chen ◽  
Jianping Chen ◽  
Henry Chung
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Asian Americans ◽  
Mental Health Professionals ◽  
Primary Care Providers ◽  
Care Providers ◽  
Bridge Program ◽  
Community Awareness

Compared to all other racial and ethnic groups, Asian Americans have the lowest utilization of mental health services. Contributing factors include extremely low community awareness about mental health, a lack of culturally competent Asian American mental health professionals, and severe stigma associated with mental illness. This manuscript describes an innovative program that bridges the gap between primary care and mental health services. The Bridge Program, cited in the supplement to the Surgeon’s General’s Report on Mental Health: Culture, Race, and Ethnicity as a model for delivery of mental health services through primary care; (2) to improve capacity by enhancing the skills of primary care providers to identify and treat mental disorders commonly seen in primary care; and (3) to raise community awareness by providing health education on mental health and illness. Results are presented and the potential for replication is addressed.

scholarly journals Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 10-11
Author(s):  
Victoria Grando ◽  
Roy Grando
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Treatment Plan ◽  
Primary Care Providers ◽  
Neurocognitive Disorders ◽  
Mental Condition ◽  
Care Providers

Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.

Introducing Shared Mental Health Care in Northwestern Ontario: An Analysis of Changing Referral Patterns of Primary Care Providers

2015 ◽  
Vol 34 (2) ◽  
pp. 63-72 ◽  
Author(s):  
Graham Gaylord ◽  
S. Kathleen Bailey ◽  
John M. Haggarty
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Community Mental Health Services ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns

This study describes a shared mental health care (SMHC) model introduced in Northern Ontario and examines how its introduction affected primary care provider (PCP) mental health referral patterns. A chart review examined referrals (N = 4,600) from 5 PCP sites to 5 outpatient community mental health services from January 2001 to December 2005. PCPs with access to SMHC made significantly more mental health referrals (p < 0.001). Two demographically similar PCPs were then compared, one co-located with SMHC. Referrals for depression to non-SMHC mental health services were 1.69 times more likely to be from the PCP not co-located with SMHC (p < 0.001). Findings suggest SMHC increases access to care and decreases demand on existing mental health services.

scholarly journals Predicting Women’s Utilization of Primary Care Mental Health Services in Mexico City

2016 ◽  
Vol 8 (2) ◽  
pp. 83-88
Author(s):  
Karla Mendoza ◽  
Arianna Ulloa ◽  
Nayelhi Saavedra ◽  
Jorge Galván ◽  
Shoshana Berenzon
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mexico City ◽  
Primary Care Providers ◽  
Mental Health Provider ◽  
Care Providers ◽  
Chi Square ◽  
Primary Care Mental Health

Objective: To analyze factors associated with and predicting Mexican women seeking primary care mental health services (PCMHS) and provide suggestions to increase PCMHS utilization. Method: We administered a questionnaire to (N = 456) female patients in Mexico City primary care clinics. We conducted chi-square analyses of seeking PCMHS and sociodemographic variables, perceptions of and experiences with PCMHS. Our results and literature review guided our logistic regression model. Results: Women referred to a mental health provider (MHP; odds ratio [OR] = 10.81, 95% CI = 3.59-32.51), whose coping mechanisms included talking to a MHP (OR = 5.53, 95% CI = 2.10-14.53), whose primary worry is loneliness (OR = 8.15, 95% CI = 1.20-55.10), and those who follow doctor’s orders; were more likely to seek PCMHS (OR = 0.28, 95% CI = 0.09-0.92). Conclusions: Primary care providers play a fundamental role in women’s decisions to seek PCMHS. Proper referrals to PCMHS should be encouraged.

scholarly journals Readiness to Deliver Person-Focused Care in A Fragile Situation: The Case of Mental Health Services in Lebanon

2020 ◽  
Author(s):  
Aya Noubani ◽  
Karin Diaconu ◽  
Giulia Loffreda ◽  
Shadi Saleh
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Health Care Providers ◽  
Mental Healthcare ◽  
Care Providers ◽  
Health Seeking

Abstract Background: Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support (MHPSS) service provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.Methods: A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results: Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care.Conclusion: Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to 1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and 2) promote the implementation of integrated person focused care for addressing mental health.

scholarly journals Readiness to deliver person‐focused care in a fragile situation: the case of Mental Health Services in Lebanon

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Aya Noubani ◽  
Karin Diaconu ◽  
Giulia Loffreda ◽  
Shadi Saleh
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Health Care Providers ◽  
Mental Healthcare ◽  
Care Providers ◽  
Health Seeking

Abstract Background Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model. Methods A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care. Conclusions Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to (1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and (2) promote the implementation of integrated person focused care for addressing mental health.

P047 PARENT PERSPECTIVES ON COMPREHENSIVE CARE FOR CHILDREN WITH INFLAMATORY BOWEL DISEASES: BUILDING A CARE DELIVERY MODEL FROM THE FAMILY UP

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
Hilary Michel ◽  
Sandra Kim ◽  
Nalyn Siripong ◽  
Robert Noll
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Primary Care Providers ◽  
Shared Responsibility ◽  
Parent Perspectives ◽  
Healthcare Needs ◽  
Bowel Diseases

Abstract Background Patients with Inflammatory Bowel Diseases (IBD) require life-long management by gastroenterology (GI) and primary care providers (PCP). Guidelines exist outlining recommended healthcare services, but it is unclear which provider is responsible for which tasks, and what parents prefer. Aims To understand perceptions of healthcare quality and delivery for children with IBD, describe barriers to receiving comprehensive healthcare, and elicit preferences for how care would ideally be delivered. Methods Cross-sectional survey of parents of children ages 2–17 with IBD at a large, free-standing children’s hospital, recruited via an institutional research registry. Surveys assessed patient medical history, family demographics, perceptions of health care quality and delivery, barriers to primary and GI care, and preferences for care receipt. Results 217 parents were recruited, 214 consented, and 161 completed the survey (75% response). Mean patient age 14 years (SD 3); 51% male; 80% Crohn’s, 16% ulcerative colitis, and 4% indeterminate colitis. Most parents were Caucasian (94%), had a bachelor’s degree or higher (61%), and lived in a suburban setting (57%). Most had private insurance (43%) or private primary and public secondary insurance (34%). Most parents (N=149, 94%) thought the GI doctor was responsible for their child’s IBD care, and 8 (6%) reported shared responsibility by the GI doctor and PCP. 113 (71%) said their child’s PCP was responsible for primary care, 8 (5%) said GI doctor, and 37 (23%) said both. 95% of parents were confident in their GI doctor’s primary care knowledge, and 81% with their PCP’s IBD knowledge. 89% were satisfied with their communication with the PCP, and 98% were satisfied with their communication with the GI doctor. 53% did not know how well their PCP and GI doctors were communicating with each other. Only 4% of parents reported unmet healthcare needs, but those who did cited inadequate family support and mental health services. The greatest barriers to PCP care were lack of continuity with providers (22%) and scheduling (24%). The greatest barriers to GI care were scheduling (38%) and traveling to appointments (29%). Parent preferences for specific health care service delivery are found in Figure 1. Conclusions Parents of children with IBD are satisfied with provider knowledge and communication skills with them, though most are unaware how well their PCP and GI doctor are communicating with each other. Healthcare needs are being met for most patients in our cohort, but parents cite different barriers to primary vs. specialty care, and mental health services in particular are lacking. Parents seem to support co-management between their child’s PCP and GI provider. Understanding parent perspectives is essential to the development of family-centered healthcare delivery models for children with IBD.

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