Department of Psychology.
Department of Psychiatry and Behavioral Sciences.
Fam Syst Health. 2022 Mar;40(1):35-45. doi: 10.1037/fsh0000637. Epub 2021 Nov 4.
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).
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.
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.
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).
退伍军人事务部（VA）的初级保健-心理健康一体化（PC-MHI）计划针对抑郁（MDD）、焦虑/创伤后应激障碍（PTSD）和酒精使用障碍（AM）进行了改善。在初级保健中，病例发现通常依赖于抑郁筛查。虽然临床实践指南仅为抑郁的管理提供信息，但当精神症状群共存时，很少有信息可以指导治疗。我们为初级保健中的护理规划者提供了关于 VA PC 患者的描述性临床信息，这些患者仅患有抑郁、抑郁加酒精使用障碍以及抑郁伴复杂精神共病（PTSD 和/或可能的双相情感障碍）。
我们检查了 VA 一项研究的数据，该研究使用基于就诊的抽样程序对 10929 名 VA 初级保健患者进行了抑郁筛查；761 名患有可能的重度抑郁症患者完成了健康和护理参与的基线评估。在 7 个月时完成了随访评估。
在基线时，53%的患者除了抑郁外还存在心理健康问题；10%有并发 AM，43%有精神上复杂的抑郁（有或没有 AM）。与仅患有抑郁或抑郁伴 AM 的患者相比，患有精神上复杂的抑郁的患者表现出更长时间的、更严重的情绪障碍、更高的自杀意念可能性、更高的失业和更高水平的多药治疗。基线抑郁复杂性预测了随访时更差的心理健康状况和功能。
相当一部分 VA 初级保健中患有抑郁的患者表现出较高的医疗共病和升高的安全担忧。精神上复杂的抑郁预测了较低的治疗效果，这表明 PC-MHI 干预措施应该为这些患者协调和个性化护理。
