Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.

ABSTRACT

BACKGROUND: Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. OBJECTIVES: Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. RESEARCH DESIGN: Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings. SUBJECTS: Office visits from 2007 to 2010 were pooled for adults aged 35-85 with a depression diagnosis at the time of visit (N=3659 visits). MEASURES: Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. RESULTS: Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (P<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. CONCLUSIONS: Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves toward an integrated care model.