Mental health screening in primary care helps veterans

August 13, 2014
Mental health screening in primary care helps veterans

Veterans who receive mental health screening during primary care visits are generally getting adequate follow-up treatment, but the process for acquiring care could be improved, finds a new study in General Hospital Psychiatry. The study examined primary care screening for depression, post-traumatic stress disorder (PTSD) and alcohol misuse at a large Veterans Affairs (VA) medical center.

"For all three screens [depression, PTSD, and alcohol misuse], we looked at the provision of treatments that receive A-level recommendations in the VA-Department of Defense clinical practice guidelines for the related disorder. This means that in patients who actually have the disorder, there is good evidence that the intervention improves important health outcomes and benefits substantially outweigh harm," said lead author Brian Shiner, M.D., M.P.H., staff psychiatrist at the White River Junction VA Medical Center and assistant professor at the Geisel School of Medicine at Dartmouth. "Therefore, we assume that we can help to improve veterans' health by following up screens with clinical exams and delivering these treatments when they are indicated."

Shiner and his colleagues analyzed three screening tests given in 2011 to primary care patients at the White River Junction VA Medical Center. These patients did not have prior .

Of the 20,682 patients seen for primary care, 3,272 screened positive for one or more . Of patients with positive screens, 16 percent screened positive for depression, 12 percent for PTSD, and 84 percent for alcohol misuse. These percentages include 10 percent that were positive for two or more disorders.

The study found that, post-screening, those who went on to mental health clinics received recommended care. Patients identified with alcohol misuse issues often didn't receive recommended medications, however, "we should use caution in interpreting the findings on alcohol misuse," noted Shiner.

"A positive screen on the [screening tool] identifies both alcohol misuse and alcohol dependence. Different treatments are appropriate for these two problems," he explained. "In , brief counseling in primary care receives an A-level recommendation from the VA and Department of Defense. With , medications like naltrexone receive an A-level recommendation, but this report does not disentangle these populations."

Rick Hafer, Ph.D., clinical professor of psychiatry and vice chairman of clinical services in the department of psychiatry at the University of Wisconsin School of Medicine and Public Health, said pre-screening in primary care clinics is important since it might identify patients who may not seek services or they will wait until their symptoms become more severe.

"Early detection and treatment for mental health is similar to other medical conditions. Early intervention leads to more effective, efficient care," he said. "Since more than 60 percent of are treated in primary care, it is important to develop pre-screening tools to better evaluate mental health conditions and early intervention."

"Keep in mind some patients see their 'mental health problems' as private, only to be shared with a mental health specialist," said Hafer. "The main limitation to rests with whether clinicians are available in addition to medication intervention. But many do not want medications but prefer some form of therapy."

Explore further: Better diagnoses yield improved treatment for vets with anxiety

Related Stories

Better diagnoses yield improved treatment for vets with anxiety

December 6, 2013
Veterans who suffer from anxiety may not get appropriate treatment for want of a specific diagnosis, finds a new study in General Hospital Psychiatry.

Inadequate mental health care for blacks with depression and diabetes, high blood pressure

July 25, 2014
A new study in General Hospital Psychiatry confirms that blacks with depression plus another chronic medical condition, such as Type 2 diabetes or high blood pressure, do not receive adequate mental health treatment.

Brief counseling for drug use doesn't work, study finds

August 5, 2014
In an effort to stem substance use, the U.S. has invested heavily in the past decade in a brief screening-and-intervention protocol for alcohol and other drugs.

Rural primary care physicians offer insight into rural women's health care

February 5, 2014
Women living in rural communities are less likely than urban-dwelling women to receive sufficient mental health care, in large part due to limited access to services and societal stigma, according to medicine and public health ...

War veterans with mental health diagnoses more likely to receive prescription opioids for pain

March 6, 2012
Iraq and Afghanistan war veterans with mental health diagnoses, particularly posttraumatic stress disorder, are more likely to receive prescription opioid medications for pain-related conditions, have higher-risk opioid use ...

Electronic screening tool to triage teenagers and risk of substance misuse

July 28, 2014
An electronic screening tool that starts with a single question to assess the frequency of substance misuse appears to be an easy way to screen teenagers who visited a physician for routine medical care.

Recommended for you

Study finds gene variant increases risk for depression

July 20, 2017
A University of Central Florida study has found that a gene variant, thought to be carried by nearly 25 percent of the population, increases the odds of developing depression.

Study examines effects of stopping psychiatric medication

July 20, 2017
Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals, according ...

In making decisions, are you an ant or a grasshopper?

July 20, 2017
In one of Aesop's famous fables, we are introduced to the grasshopper and the ant, whose decisions about how to spend their time affect their lives and future. The jovial grasshopper has a blast all summer singing and playing, ...

Perceiving oneself as less physically active than peers is linked to a shorter lifespan

July 20, 2017
Would you say that you are physically more active, less active, or about equally active as other people your age?

New study suggests that reduced insurance coverage for mental health treatment increases costs for the seriously ill

July 19, 2017
Higher out-of-pocket costs for mental health care could have the unintended consequence of increasing the use of acute and involuntary mental health care among those suffering from the most debilitating disorders, a Harvard ...

Old antibiotic could form new depression treatment

July 19, 2017
An antibiotic used mostly to treat acne has been found to improve the quality of life for people with major depression, in a world-first clinical trial conducted at Deakin University.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.