Literature Collection

The primary care office is an essential part of the mental health system. Overall, at least half of all visits to clinicians for mental health conditions are to primary care physicians. The collaborative care model, which integrates behavioral health services into the primary care office, has been shown to improve patient outcomes and is cost-effective. The five essential components of the collaborative care model include team-driven care, population-focused care, measurement-guided care, evidence-based care, and accountable care. To assist with counseling patients during office visits, multiple brief interventions have been created and/or adapted from longer interventions. Some of these tools include the Five As behavioral change model; the background, affect, troubling, handling, empathy (BATHE) technique; the feedback, responsibility, advice, menu of strategies, empathy, self-efficacy (FRAMES) model, and the stages of change model (ie, transtheoretical model). Use of brief interventions has been shown to result in modest improvements in mental health outcomes in the short-term. These interventions can be applied to patients with anxiety, depression, and substance use disorders.

OBJECTIVE: The goal was to examine psychiatric diagnosis rates among a national cohort of primary care patients with and without obesity. METHODS: The cohort was derived from national Veterans Health Administration data (women, N=342,262; men, N=4,524,787). Sex-stratified descriptive statistics characterized psychiatric diagnosis rates. Chi-square tests determined whether diagnosis rates differed by obesity status (α=0.001). RESULTS: Rates of any psychiatric diagnosis were higher among women than among men and among people with obesity versus without obesity (women, 53.9% vs. 50.4%; men, 37.9% vs. 35.2%). Depression and posttraumatic stress disorder diagnosis rates were higher for people with obesity, and substance use disorder diagnosis rates were lower for people with obesity. Anxiety diagnosis rates were slightly lower among women with obesity versus women without obesity. CONCLUSIONS: Programs simultaneously addressing weight management and mental health could address the psychiatric comorbidities observed among people with obesity. Women are most likely to need these services.

Purpose: Primary care is an ideal setting to deliver efficacious treatments for opioid use disorder (OUD). Primary care providers need to be aware of other concerns patients with OUD might have in order to provide comprehensive care. This study describes the prevalence of mental health, comorbid substance use, and psychosocial concerns of patients seeking treatment for OUD in primary care and their relation to 6-month treatment retention. Methods: Patients (N = 100; M age = 34.9 years (SD = 10.8), 74% white, 46% female) with OUD who were starting treatment with buprenorphine at an academic family medicine residency clinic completed surveys of mental health concerns (depression, anxiety, trauma), psychosocial needs (food insecurity, income, transportation, employment), and demographic variables. Chart reviews were conducted to gather information on comorbid substance use, mental health diagnoses, and 6-month treatment retention. Results: Mental health symptoms were highly prevalent in this sample (44% screened positive for anxiety, 31% for depression, and 52% for posttraumatic stress disorder). Three-quarters reported use of illicit substances other than opioids. Many patients also had significant psychosocial concerns, including unemployment (54%), low income (75%), food insecurity (51%), and lacking reliable transportation (64%). Two-thirds (67%) of the sample were retained at 6 months; patients who previously used intravenous opioids were more likely to discontinue treatment (P = .003). Conclusions: Many patients receiving treatment for OUD have significant mental health problems, comorbid substance use, and psychosocial concerns; interestingly, none of these factors predicted treatment retention at 6 months. Primary care clinics would benefit from having appropriate resources, interventions, and referrals for these comorbid issues in order to enhance overall patient well-being and promote recovery.