Journal of General Internal Medicine

, Volume 12, Issue 7, pp 403–406

Patients' perspectives on the management of emotional distress in primary care settings

  • David S. Brody
  • Amir A. Khaliq
  • Troy L. Thompson
Original Articles

Abstract

Objective

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.

Design

Patient surveys.

Setting

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.

Conclusions

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.

Key Words

patient expectations emotional distress patient treatment desires primary care mental health problems 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267:1478–83.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    Schulberg HC, Burns BJ. Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions. Gen Hosp Psychiatry. 1988;10:79–87.PubMedCrossRefGoogle Scholar
  7. 7.
    Kessler LG, Cleary PD Jr. Psychiatric disorders in primary care: results of a follow-up study. Arch Gen Psychiatry. 1985;42:583–7.PubMedGoogle Scholar
  8. 8.
    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.PubMedGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Von Korff M, Myers L. The primary care physician and psychiatric services. Gen Hosp Psychiatry. 1987;9:235–40.CrossRefGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Goldberg D. A classification of psychological distress for use in primary care settings. Soc Sci Med. 1992;35:189–93.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Eisenthal S, Emery R, Lazare A, et al. Adherence and the negotiated approach to patienthood. Arch Gen Psychiatry. 1979;36:393.PubMedGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 1997

Authors and Affiliations

  • David S. Brody
    • 1
  • Amir A. Khaliq
    • 1
  • Troy L. Thompson
    • 2
  1. 1.Hahnemann Division of General Internal MedicineAllegheny University HospitalsPhiladelphia
  2. 2.Division of General Internal Medicine, Allegheny University Hospitals, hahnemann DivisionJefferson Medical College of Thomas Jefferson UniversityPhiladelphia

Personalised recommendations