Literature Collection

Objective: Collaborative care models (CoCMs) are modalities for treating mental health conditions in primary care. One such iteration of CoCM, antidepressant monitoring (ADM), is a pharmacologic treatment modality for the management of depression and anxiety. ADM programs have established efficacy, yet little is known about ideal patient selection or approaches related to program retention. The objective of this study was to address this need by examining predictors of referral from a CoCM ADM program to higher levels of psychiatric services. Methods: A retrospective cohort analysis was conducted on individuals enrolled in the Tampa Veterans' Affairs ADM program over 18 months (from June 4, 2018, through December 4, 2019). Data collected included information related to referral to a higher level of service, as well as baseline information and covariates of interest. Primary analysis was conducted utilizing a multivariable logistic regression model to evaluate whether baseline characteristics were associated with differences in referral rates to higher-level services. Results: A total of 757 veterans were included in the analyses, with 131 (17.31%) referred on to a higher level of service for specialty psychiatric care. Multivariable modeling showed the following covariates to be associated with higher rates of referral to specialty psychiatric services: baseline 9-item Patient Health Questionnaire scores, sleep issues at the time of enrollment, alcohol use disorder, and cannabis use disorder. Conclusions: Results show low rates of referral overall but identify a number of baseline characteristics associated with higher referral rates to specialty psychiatric services. Further research is needed, including prospective work and studies examining proactive interventions to limit required referrals to specialty mental health services. Prim Care Companion CNS Disord 2026; 28(2):25m04149. Author affiliations are listed at the end of this article.

The importance of fear has been emphasized in research and treatment focusing on persistent physical symptoms (PPS). Recognizing a broader range of emotions may inform theory and personalized care. This study aimed to examine what basic emotions individuals with PPS experience related to their physical symptoms, the correlations between such emotions and overall somatic symptom burden and disability, and whether emotions change with treatment. Analyses drew on data from a randomized controlled trial that compared internet-delivered exposure therapy with healthy lifestyle promotion for patients with PPS (n = 159), supplemented by data from age- and gender-matched healthy volunteers (n = 160). Participants self-reported emotions related to their physical symptoms. Mean differences were evaluated within a linear regression modeling framework. Compared with the healthy volunteers, PPS participants scored significantly higher on anger, disgust, fear, sadness, and shame, and lower on joy. Disgust, fear, sadness, and shame correlated significantly with somatic symptom burden; anger, fear, sadness, and shame with disability. All negatively valenced emotions reduced significantly in both interventions, without significant between-group effects. Joy increased significantly in exposure. These results highlight the potential relevance of diverse emotions in PPS. To facilitate personalized care, future work could evaluate the unique contribution of specific emotions to clinical outcomes.

There is strong evidence supporting the efficacy of cognitive behavioral therapy (CBT) for the treatment of numerous clinical conditions commonly present in primary care. CBT interventions are time limited and goal directed, which allows them to be implemented within primary care settings. CBT techniques can be implemented effectively at the bedside at each stage of care throughout the lifespan to enhance mental and physical functioning. It is important for primary care clinicians to be empowered to utilize nonpharmacological techniques such as CBT while also recognizing the limits of their expertise and training in CBT.