Journal of General Internal Medicine

, Volume 28, Issue 3, pp 346–352

Integrated Care: Treatment Initiation Following Positive Depression Screens

  • Benjamin R. Szymanski
  • Kipling M. Bohnert
  • Kara Zivin
  • John F. McCarthy
Original Research

DOI: 10.1007/s11606-012-2218-y

Cite this article as:
Szymanski, B.R., Bohnert, K.M., Zivin, K. et al. J GEN INTERN MED (2013) 28: 346. doi:10.1007/s11606-012-2218-y

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.

KEY WORDS

depression screeningintegrated careveterans

Supplementary material

11606_2012_2218_MOESM1_ESM.pdf (146 kb)
ESM 1(PDF 145 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Benjamin R. Szymanski
    • 1
  • Kipling M. Bohnert
    • 2
    • 3
  • Kara Zivin
    • 2
    • 3
  • John F. McCarthy
    • 2
    • 3
  1. 1.Department of Chronic Disease EpidemiologyYale School of Public HeathNew HavenUSA
  2. 2.Serious Mental Illness Treatment Resource and Evaluation CenterDepartment of Veterans AffairsAnn ArborUSA
  3. 3.Department of PsychiatryUniversity of MichiganAnn ArborUSA