Interest and Use of Mental Health and Specialty Behavioral Medicine Counseling in US Primary Care Patients

  • Kelly G. Baron
  • Emily Lattie
  • Joyce Ho
  • David C. Mohr



Counseling interventions have the potential to improve health and quality of life for primary care patients, but there are few studies describing the interest in and utilization of counseling among this patient population in the USA.


The purpose of the study was to evaluate interest in mental health and specialty behavioral medicine counseling and predictors of utilization over 1 year among US primary care patients.


Participants in this two-survey longitudinal study included 658 primary care patients in an urban US academic medical center (461 females, age M = 51.05, SD = 15.46 years). Retention rate was 61.2% at survey 2. Patient demographics, depression, anxiety, and interest in counseling services were assessed through a survey mailed 1 week following an outpatient appointment. Respondents to survey 1 were re-contacted 1 year later to assess. Interest and use of the following counseling services were evaluated in the relevant subgroups: mental health (the entire sample and patients with elevated anxiety and/or depression), health/lifestyle (overweight and obese participants), smoking cessation (current and occasional smokers), and pain management (participants with elevated daily pain ratings).


At survey 1, 45.7% of the sample reported interest in mental health counseling, and 58.9% of the sample reported interest in behavioral medicine counseling. Among overweight or obese participants, 59.9% were interested in health/lifestyle counseling. Among smokers, 55.3% were interested in smoking cessation, and among participants with chronic pain, 33.8% were interest in pain management. Rates of utilization of services at survey 2 were 21.3% for mental health, 7.7% for health/lifestyle, 6.7% for smoking cessation, and 6.6% for pain management. Interest in receiving services at survey 1 was the strongest predictor of utilization.


Results demonstrate high interest but low utilization over 1 year among US primary care patients. Identifying patients interested in counseling services and reducing barriers may help facilitate receipt of services for those with interest and need for behavioral treatments.


Counseling Behavioral medicine Primary care Obesity Chronic pain Smoking cessation 



Work on this project was supported by R01-MH59708 and T32 HS00078 from the Agency for Healthcare Research and Quality, and K12HD055884 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. 1K23HL109110-01 from the National Heart Lung and Blood Institute.


  1. 1.
    Anderson NB. Encyclopedia of health. Thousand Oaks: Sage; 2004.Google Scholar
  2. 2.
    Nyman JA, Barleen NA, Dowd BE. A return-on-investment analysis of the health promotion program at the University of Minnesota. J Occup Environ Med. 2009;51(1):54–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Baker KM, Goetzel RZ, Pei X, Weiss AJ, Bowen J, Tabrizi MJ, et al. Using a return-on-investment estimation model to evaluate outcomes from an obesity management worksite health promotion program. J Occup Environ Med. 2008;50(9):981–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Report. 2008;56(10).Google Scholar
  5. 5.
    Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Parslow RA, Lewis V, Marsh G. The general practitioner’s role in providing mental health services to Australians, 1997 and 2007: findings from the national surveys of mental health and wellbeing. Med J Aust. 2011;195(4):205–9.PubMedGoogle Scholar
  7. 7.
    Ammerman AS, Lindquist CH, Lohr KN, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med. 2002;35(1):25–41.PubMedCrossRefGoogle Scholar
  8. 8.
    Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med. 2010;8:38.PubMedCrossRefGoogle Scholar
  9. 9.
    Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev. 2010(1):CD006936.Google Scholar
  10. 10.
    Tsai AG, Wadden TA. Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med. 2009;24(9):1073–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Stead LF, Bergson G, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev. 2008(2):CD000165.Google Scholar
  12. 12.
    Allison KC, Lundgren JD, O’Reardon JP, Martino NS, Sarwer DB, Wadden TA, et al. The Night Eating Questionnaire (NEQ): psychometric properties of a measure of severity of the Night Eating Syndrome. Eat Behav. 2008;9(1):62–72.PubMedCrossRefGoogle Scholar
  13. 13.
    Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, et al. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med. 2010;7:1–11.Google Scholar
  14. 14.
    Wang J. Perceived barriers to mental health service use among individuals with mental disorders in the Canadian general population. Med Care. 2006;44(2):192–5.PubMedCrossRefGoogle Scholar
  15. 15.
    van Beljouw I, Verhaak P, Prins M, Cuijpers P, Penninx B, Bensing J. Reasons and determinants for not receiving treatment for common mental disorders. Psychiatr Serv. 2010;61(3):250–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system survey questionnaire. In: Services USDoHaH, editor. Atlanta, Georgia 2006.Google Scholar
  17. 17.
    Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health survey: manual and interpretation guide. Boston: Health Institute, New England Medical Centre; 1993.Google Scholar
  18. 18.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1–3):163–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Binks M, O’Neil MP. Referral sources to a weight management program: relation to outcome. J Gen Intern Med. 2002;17(8):596–603.PubMedCrossRefGoogle Scholar
  22. 22.
    Mojtabai R. Americans’ attitudes toward mental health treatment seeking: 1990–2003. Psychiatr Serv. 2007;58(5):642–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Burgess PM, Pirkis JE, Slade TN, Johnston AK, Meadows GN, Gunn JM. Service use for mental health problems: findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2009;43(7):615–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Sareen J, Jagdeo A, Cox BJ, Clara I, ten Have M, Belik SL, et al. Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands. Psychiatr Serv. 2007;58(3):357–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Mohr DC, Hart SL, Howard I, Julian L, Vella L, Catledge C, et al. Barriers to psychotherapy among depressed and nondepressed primary care patients. Ann Behav Med. 2006;32(3):254–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. 2005;352(24):2515–23.PubMedCrossRefGoogle Scholar
  27. 27.
    Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):603–13.PubMedCrossRefGoogle Scholar
  28. 28.
    Weddington Jr WW. Adherence by medical-surgical inpatients to recommendations for outpatient psychiatric treatment. Psychother Psychosom. 1983;39(4):225–35.PubMedCrossRefGoogle Scholar
  29. 29.
    Meadows GN, Burgess PM. Perceived need for mental health care: findings from the 2007 Australian Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2009;43(7):624–34.PubMedCrossRefGoogle Scholar
  30. 30.
    Krist AH, Woolf SH, Johnson RE, Rothemich SF, Cunningham TD, Jones RM, et al. Patient costs as a barrier to intensive health behavior counseling. Am J Prev Med. 2010;38(3):344–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Balasubramanian BA, Cohen DJ, Clark EC, Isaacson NF, Hung DY, Dickinson LM, et al. Practice-level approaches for behavioral counseling and patient health behaviors. Am J Prev Med. 2008;35(5 Suppl):S407–13.PubMedCrossRefGoogle Scholar
  32. 32.
    Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G. Computer-aided psychotherapy for anxiety disorders: a meta-analytic review. Cogn Behav Ther. 2009;38(2):66–82.PubMedCrossRefGoogle Scholar
  33. 33.
    Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006;166(15):1620–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Strecher VJ, McClure JB, Alexander GL, Chakraborty B, Nair VN, Konkel JM, et al. Web-based smoking-cessation programs: results of a randomized trial. Am J Prev Med. 2008;34(5):373–81.PubMedCrossRefGoogle Scholar
  35. 35.
    Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205.PubMedCrossRefGoogle Scholar
  36. 36.
    Tate DF, Finkelstein EA, Khavjou O, Gustafson A. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med. 2009;38(1):40–5.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2011

Authors and Affiliations

  • Kelly G. Baron
    • 1
  • Emily Lattie
    • 2
  • Joyce Ho
    • 2
  • David C. Mohr
    • 2
  1. 1.Department of NeurologyyFeinberg School of Medicine, Northwestern UniversityChicagoUSA
  2. 2.Department of Preventive MedicineFeinberg School of Medicine, Northwestern UniversityChicagoUSA

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