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Association Between Mental Health Staffing Level and Primary Care-Mental Health Integration Level on Provision of Depression Care in Veteran’s Affairs Medical Facilities

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Abstract

We examined the association of mental health staffing and the utilization of primary care/mental health integration (PCMHI) with facility-level variations in adequacy of psychotherapy and antidepressants received by Veterans with new, recurrent, and chronic depression. Greater likelihood of adequate psychotherapy was associated with increased (1) PCMHI utilization by recurrent depression patients (AOR 1.02; 95% CI 1.00, 1.03); and (2) staffing for recurrent (AOR 1.03; 95% CI 1.01, 1.06) and chronic (AOR 1.02; 95% CI 1.00, 1.03) depression patients (p < 0.05). No effects were found for antidepressants. Mental health staffing and PCMHI utilization explained only a small amount of the variance in the adequacy of depression care.

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Acknowledgements

This study was supported by the VA Quality Enhancement Research Initiative (QUERI) Rapid Response Project (RRP 10-105) (VSF). In addition, D.C. Cooper was supported by a VA HSR&D post-doctoral fellowship and by G.E. Reiber’s Career Scientist Award (RCS 98-353). R.B. Trivedi is supported by a VA HSR&D Career Development Award (CDA-09-206).

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Authors and Affiliations

  1. Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, 1660 Columbian Way, Seattle, WA, 98108, USA

    Denise C. Cooper, Christian D. Helfrich, Karin M. Nelson, Gayle E. Reiber, Evercita C. Eugenio, Kristine Beaver, Julie Nugent-Carney & Vincent S. Fan

  2. Department of Health Services, University of Washington, Seattle, WA, USA

    Christian D. Helfrich & Gayle E. Reiber

  3. Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA

    Stephen M. Thielke

  4. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA

    Stephen M. Thielke

  5. VA Palo Alto Health Care System, Palo Alto, CA, USA

    Ranak B. Trivedi

  6. Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA

    Ranak B. Trivedi

  7. Department of Medicine, University of Washington, Seattle, WA, USA

    Karin M. Nelson & Vincent S. Fan

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  1. Denise C. Cooper
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Correspondence to Vincent S. Fan.

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All authors are current or former employees of the Veterans Health Administration, and report no other conflict of interest. The views expressed in this article are solely those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Appendix

Appendix

Empty model analysis of the proportion of variation explained by the facility and network.

A multilevel (hierarchical) “empty” model approach was used to determine the extent to which variation in depression care was explained by organizational factors (i.e., VISN- and facility level) (Krein et al. 2002; Raudenbush and Bryk 2002). For each of the depression type (new, recurrent, and chronic depression), we examined a random intercept model with no explanatory variables included (empty model) to assess the partitioning of variability in the data between the VISN and facility levels. This showed that there was >1% variability in depression care only at the facility level, not the VISN-level (Table 5).

Table 5 “Empty” hierarchical models predicting network (VISN) and facility-level variability in adequate depression care
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Cooper, D.C., Helfrich, C.D., Thielke, S.M. et al. Association Between Mental Health Staffing Level and Primary Care-Mental Health Integration Level on Provision of Depression Care in Veteran’s Affairs Medical Facilities. Adm Policy Ment Health 45, 131–141 (2018). https://doi.org/10.1007/s10488-016-0775-9

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