Degree of primary care integration predicts job satisfaction and emotional exhaustion among rural medical and behavioral healthcare providers.

INTRODUCTION: Minimal research on integrated primary care (IPC) or integrated behavioral health (IBH) has examined clinics in rural communities. The relationships between provider burnout, job satisfaction, and IBH/IPC practices remain understudied, particularly in rural settings. METHOD: We employed an online survey of 147 medical and behavioral health care providers in primary care settings throughout Montana. Respondents self-identified as predominantly White/European American (89.4%) and female (76.7%). We tested whether degree of adherence to IBH/IPC practices concurrently predicted providers' reports of emotional exhaustion (EE), a dimension of burnout, and job satisfaction. Data were collected during the COVID-19 pandemic, in 2020. RESULTS: In multiple linear regression analyses, providers' reports of IBH/IPC practices significantly predicted EE (B = -0.036, p < .01) and job satisfaction (B = 0.123, p < .05), suggesting that higher levels of integration were linked to less EE and greater job satisfaction. DISCUSSION: Our findings contribute to the evidence base regarding the potential usefulness of IBH/IPC models. Specifically, because existing research links provider burnout and low job satisfaction with provider retention difficulties and diminished health, poor patient satisfaction and outcomes, and cost inefficiencies, our findings have potential to inform policy-level discussions regarding the use of IBH/IPC models in rural states like Montana. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Depression complexity prevalence and outcomes among veterans affairs patients in integrated primary care.

INTRODUCTION: The Veterans Health Administration (VA) Primary Care-Mental Health Integration (PC-MHI) initiative targets depression (MDD), anxiety/posttraumatic stress disorder (PTSD) and alcohol misuse (AM) for care improvement. In primary care, case finding often relies on depression screening. Whereas clinical practice guidelines solely inform management of depression, minimal information exists to guide treatment when psychiatric symptom clusters coexist. We provide descriptive clinical information for care planners about VA PC patients with depression alone, depression plus alcohol misuse, and depression with complex psychiatric comorbidities (PTSD and/or probable bipolar disorder). METHOD: We examined data from a VA study that used a visit-based sampling procedure to screen 10,929 VA PC patients for depression; 761 patients with probable major depression completed baseline measures of health and care engagement. Follow-up assessments were completed at 7 months. RESULTS: At baseline, 53% of patients evidenced mental health conditions in addition to depression; 10% had concurrent AM, and 43% had psychiatrically complex depression (either with or without AM). Compared with patients with depression alone or depression with AM, those with psychiatrically complex depression evinced longer standing and more severe mood disturbance, higher likelihood of suicidal ideation, higher unemployment, and higher levels of polypharmacy. Baseline depression complexity predicted worse mental health status and functioning at follow-up. DISCUSSION: A substantial proportion of VA primary care patients with depression presented with high medical multimorbidity and elevated safety concerns. Psychiatrically complex depression predicted lower treatment effectiveness, suggesting that PC-MHI interventions should co-ordinate and individualize care for these patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Prevalence and characteristics of universal depression screening in U.S. college health centers.

INTRODUCTION: Whereas universal depression screening has potential to increase identification of mental health concerns among college students, the prevalence of universal screening in college health centers is unknown. This study provides an estimate of the prevalence of universal depression screening at public, 4-year universities in the United States. It also documents systems-level facilitators and correlates of universal screening, as well as reasons for not screening. METHOD: Online cross-sectional survey of college health center directors and student health personnel of public 4-year universities. RESULTS: There were 131 participants who responded to the survey (25% response): 64.2% (54-74%; 95% confidence interval [CI]) of respondents reported that their clinics use universal depression screening. Characteristics associated with universal depression screening use clustered around systems-level resources, including larger student populations and health care staff, greater perceived financial resources, and shorter estimates of time required for screening. Universal screening use was also associated with respondents' awareness of the U.S. Preventive Services Task Force (USPSTF) recommendation, agreement with the evidence base supporting universal depression screening, and beliefs that codified standards support effective care. Leading reasons for not screening included: lack of mental health professionals, provider reluctance, liability concerns, and lack of clinic space. DISCUSSION: Universal depression screening is reasonably common among college health centers. Care planner discussions regarding depression screening initiatives should address resource concerns, awareness of the USPSTF recommendation and evidence base, and information about the average time it takes to screen. Future research should examine functional outcomes and implementation experiences of college health centers that have adopted universal depression screening. (PsycINFO Database Record (c) 2019 APA, all rights reserved).