TY - JOUR AU - B. L. Cornwell AU - B. R. Szymanski AU - K. M. Bohnert AU - J. F. McCarthy A1 - AB - In 2007, the Veterans Health Administration (VHA) began national implementation of Primary Care-Mental Health Integration (PCMHI) services. A major goal was to enhance mental health access and address unmet treatment needs. Integrated care services have been shown to improve depression identification1 and enhance engagement in specialty mental health treatment.2 Szymanski et al. examined a sample of VHA users in fiscal year (FY) 2010 and documented positive associations between receipt of PCMHI services on the day of a positive depression screen and initiation of depression treatment within 12 weeks.3 The authors noted as a study limitation that individuals who had received same-day PCMHI services may have had unmeasured differences in symptom severity or willingness to initiate depression treatment, as compared with other study patients.3 Also, in the years since 2010, VHA implementation of PCMHI services has expanded substantially. The present analysis re-evaluates the influence of same-day PCMHI services on initiation of depression treatment, for a more recent period and adjusting for patient propensity to have received PCMHI and/or Specialty Mental Health (SMH) clinic services on the day of the initial positive depression screen in primary care (PC). METHODS For FY2017 data, we applied methods from the FY2010 study,3 adding use of propensity score weights to adjust for patient likelihood of receiving same-day PCMHI and/or SMH services.4, 5 Generalized boosted models4, 5 were used to create the weights, with location of same-day services as the outcome. Separate propensity score–weighted logistic regressions assessed initiation within 12 weeks of antidepressant pharmacotherapy, psychotherapy, and either treatment.4 Analyses used SAS (version 9.3) and R software (version 3.4.2). The study was conducted as part of ongoing operations in the VHA Office of Mental Health and Suicide Prevention. RESULTS Table 1 presents sample characteristics, by type of services received. Compared with patients receiving same-day PCMHI, the “PC only” patients were older (38.4% vs. 23.1% were 65+ years old); less likely to be Hispanic (7.7% vs. 8.9%); more likely to be male (87.8% vs. 85.7%), married (49.2% vs. 45.8%), with a prior mental health diagnosis (16.7% vs. 13.3%) and prior VHA outpatient use (67.1% vs. 64.6%); and had lower baseline PHQ-2 (Patient Health Questionnaire) scores (4.64 vs. 4.83). AD - Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA. Brittany.Cornwell@va.gov.; , Grand Rapids, USA. Brittany.Cornwell@va.gov.; Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA.; Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA.; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA.; Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA.; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA. BT - Journal of general internal medicine C5 - Healthcare Disparities; Measures CY - United States DO - 10.1007/s11606-020-05694-5 JF - Journal of general internal medicine LA - eng M1 - Journal Article N2 - In 2007, the Veterans Health Administration (VHA) began national implementation of Primary Care-Mental Health Integration (PCMHI) services. A major goal was to enhance mental health access and address unmet treatment needs. Integrated care services have been shown to improve depression identification1 and enhance engagement in specialty mental health treatment.2 Szymanski et al. examined a sample of VHA users in fiscal year (FY) 2010 and documented positive associations between receipt of PCMHI services on the day of a positive depression screen and initiation of depression treatment within 12 weeks.3 The authors noted as a study limitation that individuals who had received same-day PCMHI services may have had unmeasured differences in symptom severity or willingness to initiate depression treatment, as compared with other study patients.3 Also, in the years since 2010, VHA implementation of PCMHI services has expanded substantially. The present analysis re-evaluates the influence of same-day PCMHI services on initiation of depression treatment, for a more recent period and adjusting for patient propensity to have received PCMHI and/or Specialty Mental Health (SMH) clinic services on the day of the initial positive depression screen in primary care (PC). METHODS For FY2017 data, we applied methods from the FY2010 study,3 adding use of propensity score weights to adjust for patient likelihood of receiving same-day PCMHI and/or SMH services.4, 5 Generalized boosted models4, 5 were used to create the weights, with location of same-day services as the outcome. Separate propensity score–weighted logistic regressions assessed initiation within 12 weeks of antidepressant pharmacotherapy, psychotherapy, and either treatment.4 Analyses used SAS (version 9.3) and R software (version 3.4.2). The study was conducted as part of ongoing operations in the VHA Office of Mental Health and Suicide Prevention. RESULTS Table 1 presents sample characteristics, by type of services received. Compared with patients receiving same-day PCMHI, the “PC only” patients were older (38.4% vs. 23.1% were 65+ years old); less likely to be Hispanic (7.7% vs. 8.9%); more likely to be male (87.8% vs. 85.7%), married (49.2% vs. 45.8%), with a prior mental health diagnosis (16.7% vs. 13.3%) and prior VHA outpatient use (67.1% vs. 64.6%); and had lower baseline PHQ-2 (Patient Health Questionnaire) scores (4.64 vs. 4.83). PP - United States PY - 2020 SN - 1525-1497; 0884-8734 T1 - Treatment Initiation Following Positive Depression Screens in Primary Care: a Propensity Score-Weighted Analysis of Integrated Mental Health Services T2 - Journal of general internal medicine TI - Treatment Initiation Following Positive Depression Screens in Primary Care: a Propensity Score-Weighted Analysis of Integrated Mental Health Services U1 - Healthcare Disparities; Measures U2 - 32495097 U3 - 10.1007/s11606-020-05694-5 VO - 1525-1497; 0884-8734 Y1 - 2020 Y2 - Jun 3 ER -