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The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
261 Results
161
Prevalence and comorbidity of common mental disorders in primary care
Type: Journal Article
Year: 2009
Publication Place: Netherlands
Abstract: OBJECTIVE: To estimate the prevalence and comorbidity of the most common mental disorders in primary care practice in Spain, using the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. DESIGN: A systematic sample of 7936 adult primary care patients was recruited by 1925 general practitioners in a large cross-sectional national epidemiological study. The PRIME-MD was used to diagnose psychiatric disorders. SETTING: 1356 primary care units proportionally distributed throughout the country. RESULTS: 53.6% of the sample presented one or more psychiatric disorder. The most prevalent were affective (35.8%), anxiety (25.6%), and somatoform (28.8%) disorders. 30.3% of the patients had more than one current mental disorder. 11.5% presented comorbidity between affective, anxiety, and somatoform disorders. CONCLUSIONS: The study provides further evidence of the high prevalence and high comorbidity of mental disorders in primary care. Given the large overlap between affective, anxiety and somatoform disorders, future diagnostic classifications should reconsider the current separation between these entities.
Topic(s):
Medically Unexplained Symptoms
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View the DOI record for Prevalence and comorbidity of common mental disorders in primary care
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View the PubMed citation for Prevalence and comorbidity of common mental disorders in primary care162
Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: BACKGROUND: To determine the prevalence, impact, and prognosis of multisomatoform disorder (MSD) over a 5-year period in a primary care population. Although somatization is prevalent in primary care, patients rarely meet Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for somatization disorder. MSD, defined as > or = 3 bothersome, medically unexplained somatic symptoms, has been proposed as a more inclusive disorder. METHODS: A total of 500 adults presenting to a primary care clinic with a physical symptom were screened with the Primary Care Evaluation of Mental Disorders. Symptom count was assessed with the Patient Health Questionnaire 15-item somatic symptom scale. Additional baseline measures included functional status and symptom characteristics. Follow-up surveys at 2 weeks, 3 months, and 5 years assessed functioning, symptom outcome, psychiatric diagnoses, and patient satisfaction. Physician surveys assessed encounter difficulty. Utilization was obtained from our health database. RESULTS: MSD had an 8% prevalence at both baseline (n = 38/500) and at 5 years (n = 33/387). MSD persisted in 21% of those with MSD at baseline, and developed in 7% of those without MSD at baseline. MSD at baseline was a predictor of MSD at 5 years (relative risk (RR) = 2.7, 1.5-5.1). MSD patients were more likely to have comorbid mental disorders (RR = 1.5, 1.1-2.3) and be rated "difficult" by their clinicians (p = .02). They also reported worse functional status at all time points assessed (p < .001 for all), were less likely to experience symptom improvement, and had higher utilization rates (34.1 versus 23.1 visits; p = .006). CONCLUSIONS: MSD identifies a group of patients who are less likely to experience symptom improvement and have significant functional impairment and higher utilization rates.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study
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View the PubMed citation for Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study165
Primary care perspectives on generalized anxiety disorder
Type: Journal Article
Year: 2004
Publication Place: United States
Abstract: Recently, there has been increased interest in the impact and treatment of anxiety disorders. However, one type of anxiety disorder, generalized anxiety disorder (GAD), has received less attention than other disorders, such as panic disorder, despite the prevalence and amenability of this disorder to treatment in the primary care setting. Rates of GAD have been found to be between 2.8% and 8.5%, with a median prevalence of 5.8%-at least twice the rate reported in the National Comorbidity Survey. Up to one third of patients presenting to primary care clinics with somatic complaints had a mood or anxiety disorder. Generalized anxiety disorder is linked to the overuse of medical services: emergency department visits, hospitalizations, diagnostic and laboratory tests, pharmacy costs, and so on. Recognition of anxiety and depression in primary care is poor, with only 23% of pure anxiety cases being recognized compared with 56% of depression cases. The various stakeholders (patients, family members, employers, and insurers) in a patient's outcome often complicate treatment of anxiety. Barriers to effective treatment include time constraints, acute disease orientation of most care systems, lack of planned follow-up and monitoring, and relative unavailability of specialist access. The collaborative care approach is designed to overcome these barriers. With this approach, the patient is provided with additional educational materials, physicians are supported by physician extenders (nurses, social workers, or expert consultants) who provide case-based feedback, follow-up, extra visits, and telephone calls to patients. Providing efficacious treatment to primary care for GAD will require improving knowledge of providers and increasing patient engagement.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Primary care perspectives on generalized anxiety disorder
166
Primary care physicians treat somatization
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: BACKGROUND: We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention. METHODS: We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitive-behavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satisfaction with the PCP. RESULTS: Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differences approach, we found that the intervention produced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (-0.80; CI: -1.55 to -0.04) and psychological (-1.06; CI: -1.83 to -0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged. CONCLUSIONS: Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.
Topic(s):
Medically Unexplained Symptoms
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167
Primary care physicians' detection of psychological distress among elderly patients
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: OBJECTIVES: Elderly persons suffer from high rates of psychological distress that are sometimes unrecognized by healthcare providers. Authors compared rates of psychological distress and physician detection among elderly and non-elderly primary-care patients and examined, among elderly patients, variables associated with distress and physician detection. METHODS: This was a national survey of a sample of 2,325 Israeli primary healthcare recipients and 67 physicians. Patients completed the General Health Questionnaire (GHQ) and background questionnaires. Physicians completed forms indicating their diagnosis and treatment and their attitudes toward elderly patients. RESULTS: Of those age 60 and over, 58.7% had a GHQ score reflecting distress, as did 49% of those age 40-59 and 30.4% of those age 18-39. There was no age-group difference in physician concordance on GHQ. In elderly patients, variables associated with GHQ psychological distress were being female, having more self-reported chronic diseases, poorer self-reported health, and more frequent primary-care clinic visits. Physician agreement with GHQ distress for elderly patients was best for female patients and patients who visited a physician more often. Physicians treated 71% of the instances of distress they noted in older patients and 42% of the GHQ-detected cases. CONCLUSIONS: Physicians appear to detect distress no less accurately among older than younger patients. A majority of elderly primary-care patients are distressed, and many of them are neither diagnosed nor treated for distress. Increased attention by primary-care physicians to possible psychological distress among elderly patients who perceive their health status as poor and those patients who visit more frequently could improve detection of distress among these elderly patients.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Primary care physicians' detection of psychological distress among elderly patients
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View the PubMed citation for Primary care physicians' detection of psychological distress among elderly patients168
Primary care psychiatry: Pertinent Arabian perspectives
Type: Journal Article
Year: 2005
Publication Place: Egypt
Abstract: There is substantive evidence of significant psychiatric morbidity among primary care patients, mainly in the form of anxiety and depressive disorders. A careful critical approach is essential for ensuring the cultural relevance, validity and reliability of the psychiatric screening instruments used to identify such morbidity. Most psychiatric morbidity among primary care patients passes undetected by the primary care practitioners. This will inevitably lead to unnecessary investigation and medication and the continuation of suffering for patients. Comorbidity and physical presentation in most instances contribute significantly to failure to detect psychiatric disorders. To deal with this problem of hidden psychiatric morbidity, carefully designed educational and training programmes need to be tailored to address the particular weaknesses and needs of primary care doctors.
Topic(s):
Education & Workforce
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, Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Primary care psychiatry: Pertinent Arabian perspectives
169
Primary care psychiatry: pertinent Arabian perspectives
Type: Journal Article
Year: 2005
Publication Place: Egypt
Abstract: There is substantive evidence of significant psychiatric morbidity among primary care patients, mainly in the form of anxiety and depressive disorders. A careful critical approach is essential for ensuring the cultural relevance, validity and reliability of the psychiatric screening instruments used to identify such morbidity. Most psychiatric morbidity among primary care patients passes undetected by the primary care practitioners. This will inevitably lead to unnecessary investigation and medication and the continuation of suffering for patients. Comorbidity and physical presentation in most instances contribute significantly to failure to detect psychiatric disorders. To deal with this problem of hidden psychiatric morbidity, carefully designed educational and training programmes need to be tailored to address the particular weaknesses and needs of primary care doctors.
Topic(s):
Education & Workforce
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Primary care psychiatry: pertinent Arabian perspectives
170
Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: BACKGROUND: Patients requiring interpreters may utilize the health care system differently or more frequently than patients not requiring interpreters; those with mental health issues may be particularly difficult to diagnose. OBJECTIVE: To determine whether adult patients requiring interpreters exhibit different health care utilization patterns and rates of mental health diagnoses than their counterparts. DESIGN: Retrospective cohort study examining patient visits to primary care (PC), express care (EC), or the emergency department (ED) of a large group practice within 1 year. PATIENTS: Adult outpatients (n = 63,525) with at least one visit within the study interval and information regarding interpreter need. MAIN MEASURES: Mean visit counts, counts of mental disorders, and somatic symptom diagnoses between patients requiring interpreters (IS patients) and not requiring interpreters (non-IS patients). KEY RESULTS: IS patients (n = 1,566) had a higher mean number of visits overall (3.10 vs. 2.52), in PC (2.54 vs. 1.95), and in ED (0.53 vs. 0.44) than non-IS patients (all p < 0.01). IS patients had a lower mean number of visits in EC than non-IS patients (0.03 vs. 0.13; p < 0.01). Interpreter need remained a significant predictor of visit count in multivariate analyses including age, sex, insurance, and clinical complexity. A greater proportion of IS patients were high utilizers (10+ visits) than non-IS patients (3.6 % vs. 1.7 %; p < 0.01). IS patients had a lower frequency of mental health diagnoses (13.9 % vs. 16.7 %), but a higher frequency of diagnoses recognized as potential somatic symptoms including diseases of the nervous (29.3 % vs. 24.2 %), digestive (22.6 % vs. 14.5 %), and musculoskeletal systems (43.2 % vs. 34.5 %), and ill-defined conditions (61 % vs. 49.9 %), all p < 0.01. CONCLUSIONS: IS patients visited PC more often than their counterparts and were more often high utilizers of care. Two sources of high utilization, mental health diagnoses and somatic symptoms, differed appreciably between our populations and may be contributing factors.
Topic(s):
Healthcare Disparities
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, Medically Unexplained Symptoms
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171
Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Introduction: A growing body of research points to regular, comprehensive mental health screening in primary care practices as an effective tool, but a thorough and efficient approach is not yet widely used. The purpose of this report is to describe the pattern of mental health-related concerns, protective and social risk factors reported by adolescents during routine well-child visits in primary care settings, and their occurrence among teens that screen positive for either depression or anxiety with brief validated measures. METHODS: A personal digital assistant-based questionnaire was administered as part of clinical care to adolescents 11 to 18 years old (N = 2184) attending preventive well-child visits in 13 pediatric and family medicine primary care practices in a northern New England practice-based research network over 18 months (2008 to 2009). Depressive and anxiety-related symptoms were assessed using the 2-question versions of the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Analyses determined the role that the protective and social risk factors played in determining who screens positive for depression and anxiety. RESULTS: In the fully adjusted model, risk factors that were significant (P < .05) predictors for a positive screen of depression included substance use (adjusted odds ratio [AOR], 2.05); stress (AOR, 3.59); anger (AOR, 1.94); and worries about family alcohol and drug use (AOR, 2.69). Among protective factors, that is, those that reduce the risk of depression, age (AOR, 0.87 for younger patients); having parents who listen (AOR, 0.34); and having more assets (AOR, 0.65) were significant. Significant predictors of screening positive for anxiety included substance use (AOR, 1.97); stress (AOR, 6.10); anger (AOR, 2.31); trouble sleeping (AOR, 1.75), and the sex of the adolescent (AOR, 1.87 for girls). Although having parents who listen was still a significant protective factor for anxiety (AOR, 2.26), other assets were not significant. CONCLUSIONS: Comprehensive primary care mental health screening that considers both anxiety and depression while including strength-based and psychosocial support questions is a helpful adjunct to clinical practices and has been done routinely by using an electronic tool at the point of care. Because certain common somatic and emotional concerns can precede depression and anxiety, routine screening for these issues along with depression and anxiety screening is suggested.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents
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View the PubMed citation for Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents172
Primary health care practitioners' tools for mental health care
Type: Journal Article
Year: 2004
Publication Place: England
Abstract: The purpose of this study was to describe and analyse the content of mental health care from the practitioner's point of view. The specific aim of this paper was to outline the types of mental health care tools and the ways in which they are used by primary health care practitioners. The data were derived from interviews with doctors and nurses (n = 29) working in primary health care in six different health care centres of the Pirkanmaa region in Finland. The data were analysed by using qualitative content analysis. The tools of mental health care used in primary health care were categorized as communicative, ideological, technical and collaborative tools. The interactive tools are either informative, supportive or contextual. The ideological tools consist of patient initiative, acceptance and permissiveness, honesty and genuineness, sense of security and client orientation. The technical tools are actions related to the monitoring of the patient's physical health and medical treatment. The collaborative tools are consultation and family orientation. The primary health care practitioner him/herself is an important tool in mental health care. On the one hand, the practitioner can be categorized as a meta-tool who has control over the other tools. On the other hand, the practitioner him/herself is a tool in the sense that s/he uses his/her personality in the professional context. The professional skills and attitudes of the practitioner have a significant influence on the type of caring the client receives. Compared with previous studies, the present informants from primary health care seemed to use notably versatile tools in mental health work. This observation is important for the implementation and development of mental health practices and education.
Topic(s):
Medically Unexplained Symptoms
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, Measures
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Reference Links:
View the DOI record for Primary health care practitioners' tools for mental health care
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View the PubMed citation for Primary health care practitioners' tools for mental health care177
Psychosomatic medicine in primary care: influence of training
Type: Journal Article
Year: 2009
Publication Place: Austria
Abstract: BACKGROUND: General practitioners (GPs) are often confronted with patients presenting somatic symptoms presumed to be decisively modulated by psychosocial factors. OBJECTIVES: We aimed to explore GPs' reported clinical routine in dealing with these patients according to the GPs' level of training in psychosomatic medicine. METHODS: A structured postal questionnaire survey was conducted among all Austrian GPs with a standardized training background in psychosomatic medicine (three levels of training; duration between one and six years) as well as in a random national sample of Austrian GPs without such training, resulting in four study subgroups. RESULTS: Respondents estimated that between 20% and 40% of their patients presenting somatic symptoms need psychosocial factors to be addressed. Study subgroups differed significantly concerning their reported diagnostic and therapeutic routine behavior patterns. Some diagnostic approaches such as clarification of lay etiology increased linearly with the level of training. The proportion of patients receiving corresponding treatment in the GP's own practice was also reported to increase with the level of training (no training: 35%, levels one and two: 46%, level three: 54%), although all subgroups estimated that over 20% of patients do not receive any corresponding treatment. CONCLUSIONS: Results point at the clinical relevance of a general training in psychosomatic medicine in primary care. They also suggest specific training effects that need to be substantiated in observational studies.
Topic(s):
Medically Unexplained Symptoms
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View the DOI record for Psychosomatic medicine in primary care: influence of training
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View the PubMed citation for Psychosomatic medicine in primary care: influence of training178
Psychosomatic medicine is a comprehensive field, not a synonym for consultation liaison psychiatry
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: There is controversy surrounding the term psychosomatic. If it is used as an equivalent of consultation liaison psychiatry, there is little justification for retaining it. Psychosomatic medicine, however, may be defined as a comprehensive interdisciplinary framework for the assessment of psychosocial factors affecting individual vulnerability, course, and outcome of any type of disease; holistic consideration of patient care in clinical practice; and integration of psychological therapies in the prevention, treatment, and rehabilitation of medical disease. Psychosomatic medicine has developed several clinimetric tools for assessing psychosocial variables in the setting of medical disease and has raised the need for specific evaluations in medical assessment. The term psychosomatic medicine today seems to be more timely than ever and provides a home for innovative and integrative thinking at the interface of behavioral and medical sciences.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Psychosomatic medicine is a comprehensive field, not a synonym for consultation liaison psychiatry
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View the PubMed citation for Psychosomatic medicine is a comprehensive field, not a synonym for consultation liaison psychiatry180
Psychosomatics: a current overview
Type: Journal Article
Year: 2011
Publication Place: England
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Psychosomatics: a current overview
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View the PubMed citation for Psychosomatics: a current overview