Mental Health Among People Presenting for Care of Physical Symptoms: The Factors Associated with Suicidality and Symptoms of Depression and Anxiety are Similar Across Specialties.

Background: To identify differences in thoughts of suicide and symptoms of depression and anxiety by specialty among people presenting for care of physical symptoms, we analyzed data from routine mental health measurement in a small multispecialty practice and asked: 1. Are there any differences in suicidality (analyzed as an answer of 1 or greater or 2 or greater on the Patient Health Questionnaire [PHQ] question 9) in non-specialty and various types of specialty care? 2. Are there any factors-including specialty-associated with symptoms of depression (mean PHQ score), PHQ thresholds (greater than 0, 3 or greater, 10 or greater), Generalized Anxiety Disorder instrument [GAD] score of 3 or greater, and either GAD score 3 or greater or PHQ score 3 or greater? and 3. What factors are associated with referral to a social worker? Methods: As part of routine specialty and non-specialty care, 13,211 adult patients completed a measure of symptoms of depression (PHQ) that included a question about suicidality and a measure of symptoms of anxiety (GAD). Factors associated with suicidality and symptoms of depression and anxiety at various thresholds, and visit with a social worker, were sought in multivariable models. Results: Accounting for potential confounding in multivariable analyses, a score higher than 0 on the suicidality question (present in 18% of people) was associated with men, younger age, English-speakers, and neurodegenerative specialty care. Symptoms of depression on their continuum and using various thresholds (28% of people had a PHQ score greater than 2) were associated with non-Spanish-speakers, younger age, women, and county insurance or Medicaid insurance. Care from the social worker was associated with PHQ score of 3 or greater and having any suicidal thoughts (score of 1 or greater on question 9) but was less common with Medicare or Commercial Insurance and less common in the unit treating cognitive decline. Conclusion: The notable prevalence of symptoms of depression and suicidality among people presenting for care of physical symptoms across specialties and the relatively similar factors associated with suicidality, symptoms of depression, and symptoms of anxiety at various thresholds suggests that both non-specialty and specialty clinicians can be vigilant for opportunities for improved mental health. Increased recognition that people seeking care for physical symptoms often have mental health priorities has the potential to improve comprehensive care strategies, alleviate distress, and reduce suicide.

Factors associated with involving the social worker in whole person, team based outpatient musculoskeletal care.

The musculoskeletal community is increasingly recognizing the importance of addressing mental and social health opportunities and incorporating psychosocial support in outpatient care. This secondary analysis of a longitudinal study evaluating the management of upper extremity conditions in a musculoskeletal integrated practice unit involving 102 adult patients (63% women, mean age 49 ± 13 years), aimed to identify demographic, clinical and psychosocial variables associated with involvement of an immediately available social worker. Additionally, we assess factors associated with patients seeking second opinions and level of self-efficacy. The only factor independently associated with meeting a social worker was greater symptoms of depression. There were no factors associated with presenting for advice from a second specialist. Self-efficacy score below 10 was independently associated with higher BMI, conditions involving the shoulder or upper arm compared to the hand or wrist, and greater symptoms of depression. When a social worker is available in an upper extremity practice, they are most welcomed and helpful for people with notable symptoms of depression, likely because a depression screen was used as a trigger for involvement. Less adaptive response to painful illness may be easier to measure and discuss, with the potential to increase attention to mental and social health.

Social work leadership in a medical school: A coordinated, compassionate COVID-19 response.

The COVID-19 pandemic has exposed the systemic inequities in our health care system and society has called for actions to meet the clinical, psychosocial and educational needs in health care settings and communities. In this paper we describe how an organized Department of Health Social Work in a medical school played a unique role in responding to the challenges of a pandemic with community, clinical, and educational initiatives that were integral to our community's health.

A health care workers mental health crisis line in the age of COVID-19.

INTRODUCTION: The COVID-19 pandemic has brought a health care crisis of unparalleled devastation. A mental health crisis as a second wave has begun to emerge in our front-line health care workers. OBJECTIVE: To address these needs, The Healthcare Worker Mental Health COVID-19 Hotline, based on crisis intervention principles, was developed and launched in 2 weeks. METHODS: Upon reflection of why this worked, we decided it might be useful to describe what we now recognize as 13-steps which led to our success. The process included the following: (1) anticipate mental health needs; (2) use leadership capable of mobilizing the systems and resources; (3) convene a multidisciplinary team; (4) delegate tasks and set timelines; (5) choose a clinical service model; (6) motivate staff as a workforce of volunteers; (7) develop training and educational materials; (8) develop personal, local, and national resources; (9) develop marketing plans; (10) deliver the training; (11) launch a 24 hr/7days per week Healthcare Worker Mental Health COVID-19 Hotline, and launch follow-up sessions for staff; (12) structure data collection to determine effectiveness and outcomes; and (13) obtain funding (not required). DISCUSSION: We believe the process we used is specifically useful for others who may want to develop a COVID-19 hotline services for health care workers and generally useful for the development of other mental health services. CONCLUSION: We hope that this process may serve as a guide for other heath care systems.