Journal of General Internal Medicine

, Volume 21, Issue 1, pp 46–50 | Cite as

Screening, assessment, and management of depression in VA primary care clinics

The behavioral health laboratory
  • David W. Oslin
  • Jennifer Ross
  • Steve Sayers
  • John Murphy
  • Vince Kane
  • Ira R. Katz
Original Articles


OBJECTIVES: The purpose of this project was to assess the utility and feasibility of a telephone-based systematic clinical assessment service, the Behavioral Health Laboratory (BHL), in the context of primary care. The BHL is a clinical service that provides primary care providers with an assessment and a summary of mental health and substance abuse (MH/SA) symptoms and provides treatment decision support, including triage to specialty MH/SA services. The BHL was implemented to assist in the evaluation of patients who screened positively for depression at an annual clinical appointment or who were identified through routine care.

METHODS: Results from systematic screening of primary care patients were extracted during a period of 6 months prior to implementation of the BHL and after implementation of the BHL. Descriptive results of the 580 evaluations conducted during this time were available.

RESULTS: Results suggest an association between the implementation of the BHL and an increase in the proportion of patients screened for depression in primary care. In addition, there was an increase in the proportion of patients who screened positively (2.8% vs 7.0%). The BHL was successful in providing a comprehensive assessment for 78% of those referred. Significant co-occurring mental illness and substance misuse were found among those assessed.

CONCLUSIONS: Introducing the BHL into primary care was associated with an apparent change in clinical practice in primary care at the Philadelphia VA Medical Center. Not only were more patients identified, the broad-based approach of the BHL identified significant comorbidity with alcohol misuse, illicit drugs, and suicidal ideation, symptoms likely to have been missed in routine clinical practice. The BHL offers a practical, low-cost method of assessment, monitoring, and treatment planning for patients identified in primary care with MH/SA needs.

Key words

depression primary care adult elderly 


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  1. 1.
    Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force Now Finds Sufficient Evidence to Recommend Screening Adults for Depression. Rockville, Md: Agency for Healthcare Research and Quality; 2002.Google Scholar
  2. 2.
    Frisher M, Collins J, Millson D, Crome I, Croft P. Prevalence of comorbid psychiatric illness and substance misuse in primary care in England and Wales. J Epidemiol Community Health. 2004;58:1036–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Bruce ML, Ten Have TR, Reynolds III CF, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004;291:1081–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Levkoff SE, Chen H, Coakley E, et al. Design and sample characteristics of the PRISM-E multisite randomized trial to improve behavioral health care for the elderly. J Aging Health. 2004;16:3–27.PubMedCrossRefGoogle Scholar
  5. 5.
    Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288:2836–45.PubMedCrossRefGoogle Scholar
  6. 6.
    Simon GE, Von Korff M, Ludman EJ, et al. Cost-effectiveness of a program to prevent depression relapse in primary care. Med Care. 2002;40:941–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Simon GE, Katon WJ, VonKorff M, et al. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry. 2001;158:1638–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Oslin DW, Sayers S, Ross J, et al. Disease management for depression and at-risk drinking via telephone in an older population of veterans. Psychosom Med. 2003;65:931–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Department of Veterans Affairs. FY2002 end of year network performance measure report, 2002.Google Scholar
  10. 10.
    Blessed G, Tominson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral gray matter. Br J Psychiatry. 1968;114:797–811.PubMedGoogle Scholar
  11. 11.
    Sheehan DV, Lecrubier Y, Sheehan K, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–33.PubMedGoogle Scholar
  12. 12.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Internal Med. 2001;16:606–13.CrossRefGoogle Scholar
  13. 13.
    Sobell L, Sobell M, Gloria L, Cancilla A. Reliability of a timeline method: assessing normal drinkers’ reports of recent drinking and a comparative evaluation across several populations. Br J Addiction. 1988;83:393–402.CrossRefGoogle Scholar
  14. 14.
    Paykel ES, Myers JK, Lindenthal JJ, Tanner J. Suicidal feelings in the general population: a prevalence study. Br J Psychiatry. 1974;124:460–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Bartels SJ, Coakley E, Oxman TE, et al. Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Am J Geriatric Psychiatry. 2002;10:417–27.CrossRefGoogle Scholar
  16. 16.
    Ware J, Kossinski M, Keller S. How to score the SF-12 (R) pyshical and mental health summary scales. 3rd edn. Lincoln, RI: QualityMetric Incorporated; 1998.Google Scholar
  17. 17.
    Food and Drug Administration. Worsening depression and suicidality in patients being treated with antidepressant medications, 2004.Google Scholar
  18. 18.
    Department of Veterans Affairs. Unique SSN’s with a Dx of depression in FY 2004 followed by primary care and/or mental health clinics, 2004.Google Scholar
  19. 19.
    Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000;283:212–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Revicki DA, Tohen M, Gyulai L, et al. Telephone versus in-person clinical and health status assessment interviews in patients with bipolar disorder. Harv Rev Psychiatry. 1997;5:75–81.PubMedGoogle Scholar
  21. 21.
    Williams S, Crouch R, Dale J. Providing health-care advice by telephone. Prof Nurse. 1995;10:750–2.PubMedGoogle Scholar
  22. 22.
    Kawas C, Karagiozis H, Resau L, Corrada M, Brookmeyer R. Reliability of the blessed telephone information-memory-concentration test. J Geriatr Psychiatry Neurol. 1995;8:238–42.PubMedGoogle Scholar
  23. 23.
    Greist JH, Jefferson JW, Wenzel KW, et al. The telephone assessment program: efficient patient monitoring and clinician feedback. MD Comput. 1997;14:382–7.PubMedGoogle Scholar
  24. 24.
    Sobell LC, Brown J, Leo GI, Sobell MB. The reliability of the alcohol timeline followback when administered by telephone and by computer. Drug Alcohol Depend. 1996;42:49–54.PubMedCrossRefGoogle Scholar
  25. 25.
    Rohde P, Lewinsohn PM, Seeley JR. Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. Am J Psychiatry. 1997;154:1593–8.PubMedGoogle Scholar
  26. 26.
    Coon GM, Pena D, Illich PA. Self-efficacy and substance abuse: assessment using a brief phone interview. J Subst Abuse Treat. 1998;15:385–91.PubMedCrossRefGoogle Scholar
  27. 27.
    Simon GE, Revicki D, VonKorff M. Telephone assessment of depression severity. J Psychiatric Res. 1993;27:247–52.CrossRefGoogle Scholar
  28. 28.
    Simpson J, Doze S, Urness D, Hailey D, Jacobs P. Telepsychiatry as a routine service—the perspective of the patient. J Telemed Telecare. 2001;7:155–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Pulier ML, Ciccone DS, Castellano C, Marcus K, Schleifer SJ. Medical versus nonmedical mental health referral: clinical decision-making by telephone access center staff. J Behav Health Serv Res. 2003;30:444–51.PubMedCrossRefGoogle Scholar
  30. 30.
    Gatz M, Reynolds CA, John R, Johansson B, Mortimer JA, Pedersen NL. Telephone screening to identify potential dementia cases in a population-based sample of older adults. Int Psychogeriatr. 2002;14:273–89.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • David W. Oslin
    • 1
    • 2
    • 3
  • Jennifer Ross
    • 1
    • 2
  • Steve Sayers
    • 1
    • 2
    • 3
  • John Murphy
    • 1
    • 4
  • Vince Kane
    • 1
  • Ira R. Katz
    • 1
    • 2
  1. 1.Philadelphia VA Medical Center and VISN 4 Mental Illness ResearchEducation, and Clinical CenterPhiladelphiaUSA
  2. 2.Section of Geriatric Psychiatry, Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Center for the Study of Addictions, Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Medicine, Division of General Internal MedicineUniversity of Pennsylvania Health SystemPhiladelphiaUSA

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