Impact of screening for mental health concerns on health service utilization and functional status in primary care patients

Abstract

Background: Mental health concerns are common in primary care patients and are often inadequately addressed by primary care physicians.

Objective: To assess the impact of screening for mental disorders in internal medicine patients.

Methods: Randomly selected patients (n = 358) visiting physicians in 2 firms of an urban academic internal medicine clinic were screened for mental disorders using the 16-item Symptom-Driven Diagnostic System for Primary Care (Upjohn Co, Kalamazoo, Mich) first-stage screening questionnaire. In the experimental firm, physicians received the screening results and then administered second-stage diagnostic modules. In the control firm, physicians were not notified of the results of the screening questionnaire. Baseline and 3-month function were assessed using the SF-36 Health Survey, the Zung Self-Rating Depression Scale, and the Sheehan Patient-Rated Anxiety Scale. Patient satisfaction and health care utilization were also assessed by questionnaire at baseline and after 3 months.

Results: Patients screening positively for any mental disorder (n = 238, 66.5%) had markedly lower baseline functional status than those screening negatively (P < .05 on all 8 SF-36 Health Survey subscales) and more total (+/- SD) outpatient visits over 3 months (4.5 +/- 5.5 vs 2.5 +/- 2.6 visits, P = .001). Among patients who screened positively, functional outcomes and patient satisfaction were similar in experimental and control groups; mean utilization (+/- SD) was lower in the experimental group (3.7 +/- 3.9 vs 5.3 +/- 6.7 total outpatient visits at 3 months, P = .06; 0.9 +/- 1.5 vs 2.1 +/- 3.7 visits to non-mental health specialists, P = .003; 0.2 +/- 0.5 vs 0.4 +/- 0.9 x-ray films per patient, P = .01). The follow-up response rate was 286 (79.9%) of 358 patients.

Conclusions: The 16-item first-stage Symptom-Driven Diagnostic System for Primary Care screening questionnaire for mental disorders can identify primary care patients who are at risk for lower functional status and higher utilization. Use of the Symptom-Driven Diagnostic System for Primary Care second-stage diagnostic modules in patients who screened positively for mental disorders was associated with lower utilization rates but had no impact on functional outcome or patient satisfaction after 3 months.