Terry Danielle L, Terry Christopher P
Robert Packer Hospital, Guthrie Medical Center, One Guthrie Square, Sayre, PA, 18840, USA.
Elmira College, Elmira, USA.
J Clin Psychol Med Settings. 2019 Dec;26(4):395-401. doi: 10.1007/s10880-019-09609-3.
Behavioral health issues like anxiety and depression negatively impact numerous aspects of primary care, including medical regimen adherence, communication, physical well-being, and engagement in beneficial health behaviors. This study aimed to examine internal and family medicine residents': (1) patterns of addressing mental health concerns (e.g., frequency of referral for psychotherapy and/or medication), (2) self-perceptions of competency in assessment and treatment of specific mental health disorders, and (3) frequency of utilization of efficacious therapeutic strategies during clinical encounters. Self-report surveys were administered to Family Medicine and Internal Medicine residents (N = 39). Descriptive analyses indicated that 81% of the time, residents discussed mental health concerns when it was the presenting concern, and routinely offered medication and psychotherapy (71% and 68% of the time, respectively). Residents felt most competent in addressing major depressive disorder and generalized anxiety disorder, and least competent in addressing somatization disorder and bipolar disorder. Residents reported that they most often used motivational interviewing (MI), followed by Cognitive Behavioral Therapy, psychoeducation, and solution-focused strategies during medical encounters. These findings highlight a need to identify barriers to addressing mental health conditions in primary care and potential gaps in training that might address low levels of perceived competency among medical residents.
焦虑和抑郁等行为健康问题会对初级保健的多个方面产生负面影响，包括药物治疗依从性、沟通、身体健康以及参与有益健康行为的情况。本研究旨在调查内科和家庭医学住院医师：（1）处理心理健康问题的模式（例如，转介心理治疗和/或药物治疗的频率），（2）对特定心理健康障碍评估和治疗能力的自我认知，以及（3）临床诊疗过程中有效治疗策略的使用频率。对家庭医学和内科住院医师（N = 39）进行了自我报告调查。描述性分析表明，81%的情况下，住院医师在心理健康问题作为主要问题时会进行讨论，并常规提供药物治疗和心理治疗（分别为71%和68%的情况）。住院医师认为在处理重度抑郁症和广泛性焦虑症方面最有能力，而在处理躯体化障碍和双相情感障碍方面能力最差。住院医师报告称，他们在医疗诊疗过程中最常使用动机性访谈（MI），其次是认知行为疗法、心理教育和聚焦解决策略。这些发现凸显了识别初级保健中处理心理健康状况的障碍以及可能弥补住院医师低水平感知能力的培训潜在差距的必要性。
