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Integrated Care: Treatment Initiation Following Positive Depression Screens

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ABSTRACT

BACKGROUND

Primary Care-Mental Health Integration (PC-MHI) may improve mental health services access and continuity of care.

OBJECTIVE

To assess whether receipt of integrated PC-MHI services on the date of an initial positive depression screen influences receipt of depression treatment among primary care (PC) patients in the Veterans Health Administration.

DESIGN

Retrospective cohort study.

SUBJECTS

Thirty-six thousand, two hundred and sixty-three PC patients with positive depression screens between October 1, 2009 and September 30, 2010.

MAIN MEASURES

Subjects were assessed for depression diagnosis and initiation of antidepressants or psychotherapy on the screening day, within 12 weeks, and within 6 months. Among individuals with PC encounters on the screening day, setting of services received that day was categorized as PC only, PC-MHI, or Specialty Mental Health (SMH). Using multivariable generalized estimating equations (GEE) logistic regression, we assessed likelihood of treatment initiation, adjusting for demographic and clinical measures, including depression screening score.

KEY RESULTS

Patients who received same-day PC-MHI services were more likely to initiate psychotherapy (OR: 8.16; 95 % CI: 6.54–10.17) and antidepressant medications (OR: 2.33, 95 % CI: 2.10–2.58) within 12 weeks than were those who received only PC services on the screening day.

CONCLUSIONS

Receipt of same-day PC-MHI may facilitate timely receipt of depression treatment.

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Acknowledgements

This study was conducted as part of the Department of Veterans Affairs (VA) Primary Care-Mental Health Integration National Evaluation (Mr. Szymanski, Dr. McCarthy) Mr. Szymanski was working at the Department of Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center at the time of the study. We acknowledge support from a post-doctoral fellowship from the VA Office of Academic Affiliations (Dr. Bohnert) and a Career Development Award from the VA Health Services Research and Development Service (CD2 10-036-1, Dr. Zivin). The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Our thanks to VA program, operations, and policy leaders regarding this manuscript.

Conflicts of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Department of Chronic Disease Epidemiology, Yale School of Public Heath, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA

    Benjamin R. Szymanski MPH

  2. Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Building 14, Room D0129, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, USA

    Kipling M. Bohnert PhD, Kara Zivin PhD & John F. McCarthy PhD

  3. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Kipling M. Bohnert PhD, Kara Zivin PhD & John F. McCarthy PhD

Authors
  1. Benjamin R. Szymanski MPH
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  2. Kipling M. Bohnert PhD
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  3. Kara Zivin PhD
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  4. John F. McCarthy PhD
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Corresponding author

Correspondence to Benjamin R. Szymanski MPH.

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Szymanski, B.R., Bohnert, K.M., Zivin, K. et al. Integrated Care: Treatment Initiation Following Positive Depression Screens. J GEN INTERN MED 28, 346–352 (2013). https://doi.org/10.1007/s11606-012-2218-y

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  • DOI: https://doi.org/10.1007/s11606-012-2218-y

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