Screening, assessment, and management of depression in VA primary care clinics - The Behavioral Health Laboratory

William Penn University, Filadelfia, Pennsylvania, United States
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2006; 21(1):46-50. DOI: 10.1111/j.1525-1497.2005.0267.x
Source: PubMed

ABSTRACT The purpose of this project was to assess the utility and feasibility of a telephone-based systematic clinical assessment service, the Behavioral Health Laboratory (BHL), in the context of primary care. The BHL is a clinical service that provides primary care providers with an assessment and a summary of mental health and substance abuse (MH/SA) symptoms and provides treatment decision support, including triage to specialty MH/SA services. The BHL was implemented to assist in the evaluation of patients who screened positively for depression at an annual clinical appointment or who were identified through routine care.
Results from systematic screening of primary care patients were extracted during a period of 6 months prior to implementation of the BHL and after implementation of the BHL. Descriptive results of the 580 evaluations conducted during this time were available.
Results suggest an association between the implementation of the BHL and an increase in the proportion of patients screened for depression in primary care. In addition, there was an increase in the proportion of patients who screened positively (2.8% vs 7.0%). The BHL was successful in providing a comprehensive assessment for 78% of those referred. Significant co-occurring mental illness and substance misuse were found among those assessed.
Introducing the BHL into primary care was associated with an apparent change in clinical practice in primary care at the Philadelphia VA Medical Center. Not only were more patients identified, the broad-based approach of the BHL identified significant comorbidity with alcohol misuse, illicit drugs, and suicidal ideation, symptoms likely to have been missed in routine clinical practice. The BHL offers a practical, low-cost method of assessment, monitoring, and treatment planning for patients identified in primary care with MH/SA needs.

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    • "The BHL is an integrated primary care/mental health care service at the PVAMC that provides comprehensive substance use and psychiatric assessments by technicians under the supervision of psychologists, nurses and a psychiatrist. The laboratory assessments included a telephonic interview consisting of socio-demographic and psychiatric measures (Oslin et al., 2006). The interview assesses information in the following domains: baseline demographic data, Mini International Neuropsychiatric Interview (MINI) modules for mood disorders, anxiety disorders, and alcohol abuse/dependence (Sheehan et al., 1998); Patient Health Questionnaire-9 item scale (PHQ-9) (Kroenke, Spitzer, & Williams, 2001), PTSD Check List (PCL) (Blanchard, Jones- Alexander, Buckley, & Forneris, 1996), history of past episodes of depression, current antidepressant medications, alcohol consumption, smoking, use of illicit substances, 5-item Paykel Scale for suicidal ideation (Paykel, Myers, Lindenthal, & Tanner, 1974), Blessed, Tominson, & Roth, (1968) (Katzman et al., 1983), Short Form-12 item scale (SF-12) (Ware, Kossinski, & Keller, 1998), Work Limitation Questionnaire (Lerner et al., 2001), treatment satisfaction, insomnia, social support, bodily pain and diet. "
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    ABSTRACT: The aim of this investigation was to assess the relationships between suicidal ideation and insomnia symptoms in Veterans misusing alcohol. Data were extracted in this retrospective chart review of Veterans referred from primary care for a behavioral health evaluation (N=161) based on evidence of heavy drinking, drug use or another behavioral problem. Suicidal ideation (SI) was assessed using the Paykel questionnaire. Insomnia symptoms were assessed with standard diary questions in an interview format and pertained to sleep latency (SL), wake after sleep onset time (WASO), sleep quality (SQ), and habitual sleep duration (HSD). The relations between suicidal ideation and insomnia symptoms were assessed using ordinal regression analyses adjusted for socio-demographic, psychiatric and addiction-related variables. Suicidal ideation was reported in 62 (39%) of the Veterans interviewed. In a multivariable model, only inadequate SQ was associated with suicidal ideation. Short sleepers were more likely to endorse suicidal ideation and have attempted suicide in the past year. In addition, older age, inadequate financial status, and the presence of a psychiatric disorder were also significantly associated with suicidal ideation in most of the adjusted models. Given their association with suicidal ideation, insomnia symptoms in Veterans misusing alcohol should prompt an assessment of underlying psychiatric and social factors.
    Addictive behaviors 10/2013; 39(2). DOI:10.1016/j.addbeh.2013.09.022 · 2.44 Impact Factor
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    • "The mission of the BHLs is to provide comprehensive psychosocial assessments (with efficient, same-day feedback summaries provided to each patient's clinician) for VHA patients in need of mental health care during primary care visits (Oslin et al., 2006). The BHLs have increased the detection of problematic substance use and suicidal ideation, symptoms which may have been missed in routine clinical practice, among veterans using VHA primary care services (Oslin et al., 2006). These existing and successful screening procedures and integrated care models make VHA primary care better equipped than perhaps any other healthcare system to implement universal IPV screening. "
    Women s Health Issues 02/2013; 23(2). DOI:10.1016/j.whi.2012.12.004 · 1.61 Impact Factor
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    • ") is a clinical service of the Veterans Affairs (VA) Medical Center that provides assessments of patients' mental health symptoms (Oslin et al., 2006). As part of the BHL assessment, patients were screened for suicide ideation (method described in Paykel et al., 1974). "
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    ABSTRACT: ABSTRACT Background: Clinical research is required to develop and evaluate suicide prevention interventions in the elderly. However, there is insufficient information available about how to best recruit suicidal older adults for such research. This study evaluated the success and efficiency of five recruitment strategies for a clinical trial on the efficacy of cognitive therapy for suicidal older men. Methods: For each strategy, the numbers of individuals approached, screened, and enrolled were calculated, and the expenses and time associated with each enrollment estimated. Men who were 60 years or older and who had a desire for suicide over the past month were eligible for the trial. Results: Of 955 individuals considered for trial, 33 were enrolled. Most enrollments were sourced from the Veterans Affairs Behavioral Health Laboratory. Recruiting form this source was also the most time and cost efficient recruitment strategy in the study. Conclusions: Recruitment strategies are effective when they are based on collaborative relationships between researchers and providers, and utilize an existing infrastructure for involving patients in ongoing research opportunities.
    International Psychogeriatrics 08/2012; 25(1):1-8. DOI:10.1017/S104161021200138X · 1.89 Impact Factor
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