Patients' perspectives on the management of emotional distress in primary care settings
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To investigate how important treatment for emotional distress is to primary care patients in general and to primary care patients with depression, and to evaluate the types of mental health interventions they desire.
Five private primary care practices.
Measurements and main results
Patients' desire for treatment of emotional distress and for specific types of mental health interventions were measured, as well as patients' ratings of the impact of emotional distress, the frequency of depressive symptoms, and mental health functioning. Of the 403 patients, 33% felt that it was “somewhat important” and 30% thought it was “extremely important” that their physician tries to help them with their emotional distress. Patient desire for this help was significantly related to a diagnosis of depression (P<.001), perceptions about the impact of emotional distress (p<.001), and mental health functioning (p<.001). Among patients with presumptive diagnoses of major and minor depression, 84% and 79%, respectively, felt that it was at least somewhat important that they receive this help from their physician. Sixty-one percent of all primary care patients surveyed and 89% of depressed patients desired counseling; 23% of all patients and 33% of depressed patients wanted a medication; and 11% of all patients and 5% of depressed patients desired a referral to a mental health specialist.
A majority of these primary care patients and almost all of the depressed patients felt that it was at least somewhat important to receive help from their physician for emotional distress. The desire for this help seems to be related to the severity of the mental health problem. Most of the patients wanted counseling, but relatively few desired a referral to a mental health specialist.
- Spitzer RL, Williams JBW, Kroenke K. et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272:1749–56. CrossRef
- Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA. 1989;262:914–9. CrossRef
- Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267:1478–83. CrossRef
- Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA. 1990;264:2524–8. CrossRef
- Kamerow DB, Pincus HA, MacDonald DI. Alcohol abuse, other drug abuse, and mental disorders in medical practice: prevalence, costs, recognition, and treatment. JAMA. 1986;255:2054–7. CrossRef
- Schulberg HC, Burns BJ. Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions. Gen Hosp Psychiatry. 1988;10:79–87. CrossRef
- Kessler LG, Cleary PD Jr. Psychiatric disorders in primary care: results of a follow-up study. Arch Gen Psychiatry. 1985;42:583–7.
- Ormel J, Koeter MWJ, van den Brink W, van de Willige G. Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry. 1991;48:700–6.
- Borus JF, Howes MJ, Devins NP, Rosenberg R, Livingston WW. Primary health care providers recognition and diagnosis of mental disorders in their patients. Gen Hosp Psychiatry. 1988;10:317–21. CrossRef
- Von Korff M, Myers L. The primary care physician and psychiatric services. Gen Hosp Psychiatry. 1987;9:235–40. CrossRef
- Orleans CT, George LK, Houpt JL, Brodie HKH. How primary care physicians treat psychiatric disorders: a national survey of family practitioners. Am J Psychiatry. 1985;142:52–7.
- Stewart AL, Hays RD, Ware JE. The MOS Short Form General Health Survey: reliability and validity in a patient population. Med Care. 1988;26:724–32. CrossRef
- Goldberg D. A classification of psychological distress for use in primary care settings. Soc Sci Med. 1992;35:189–93. CrossRef
- Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ. The relationship between patients satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989;27:1027–35. CrossRef
- Kravitz RL, Cope DW, Bhrany, V, Leake B. Internal medicine patients' expectations for care during office visits. J Gen Intern Med. 1994;9:75–81. CrossRef
- Eisenthal S, Emery R, Lazare A, et al. Adherence and the negotiated approach to patienthood. Arch Gen Psychiatry. 1979;36:393.
- Ford DE, Kamerow DB, Thompson JW. Who talks to physicians about mental health and substance abuse problems? J Gen Intern Med. 1988;3:363–9. CrossRef
- Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalance of psychiatric disorders in a primary care practice. Arch Gen Psychiatry. 1988;45:1100–6.
- Brody DS, Thompson TL, Larson DB, Ford DE, Katon WJ, Magruder KM. Strategies for counseling depressed patients by primary care physicians. J Gen Intern Med. 1994;9:569–75. CrossRef
- Catalan J, Gath DH, Anastasiades P, Bond SAK, Day A, Hall L. Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychol Med. 1991;21:1013–8. CrossRef
- Klerman GL, Budman S, Berwick D, et al. Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Med Care. 1987;25:1078–88. CrossRef
- Roter DL, Hall JA, Kern DE, Barker R, Cole KA, Roca RP. Improving physicians' interviewing skills and reducing patients' emotional distress. Arch Intern. Med. 1995:155:1877–84. CrossRef
- Brody DS, Lerman CE, Wolfson HG, Caputo GC. Improvement in physicians' counseling of patients with mental health problems. Arch Intern Med. 1990;150:993–8. CrossRef
- Patients' perspectives on the management of emotional distress in primary care settings
Journal of General Internal Medicine
Volume 12, Issue 7 , pp 403-406
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient expectations
- emotional distress
- patient treatment desires
- primary care mental health problems
- Industry Sectors
- Author Affiliations
- 1. Hahnemann Division of General Internal Medicine, Allegheny University Hospitals, Broad & Vine Sts., Mail Stop 427, Philadelphia, PA, 19102-1192, Philadelphia, Pa
- 2. Division of General Internal Medicine, Allegheny University Hospitals, hahnemann Division, Jefferson Medical College of Thomas Jefferson University, Broad & Vine Sts., Mail Stop 427, Philadelphia, PA, 19102-1192, Philadelphia, Pa