Screening for Behavioral Health Conditions in Primary Care Settings: A Systematic Review of the Literature

Mulvaney-Day, Norah; Marshall, Tina; Piscopo, Kathryn Downey; Korsen, Neil; Lynch, Seán; Karnell, Lucy Hynds; Moran, Garrett E.; Daniels, Allen S.; Ghose, Sushmita Shoma

doi:10.1007/s11606-017-4181-0

Cited by 113 publications

(104 citation statements)

References 71 publications

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“…There are a few short screening tools for detecting multiple disorders or instruments that assess more than one MED. 3,6,7 A systematic review of the literature calls "bundled screening" tools those that simultaneously assess multiple mental health disorders. There are two types of "bundled screening", which are: (1) administration of a single tool that collectively encompasses more than one health condition (individual tools that assess more than one mental or substance use disorder in a single instrument) and, (2) administration of several brief instruments at the same time for isolated health conditions (tools that assess only one mental disorder using five or fewer items).…”

Section: Scale-2 (Gad-2) El Elemento 3 Del Alcohol Use Disorders Idementioning

confidence: 99%

“…3 The advantage of compiling multiple disorders in the Mini-SMD is that it brings together evaluation items that are common in several MEDs (e.g., depression and anxiety).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…2 Several factors contribute to these low rates, such as poor funding for mental health and inappropriate infrastructure for referral patients. 3 Gonçalves et al 4 reported that training Brazilian PHC staff in shared mental health care for a limited period of time was ineffective to improve MEDs recognition. One possibility for early detection would be training health care professionals to use screening tools and structured interviews, together with theoretical and practical mental health training.…”

Section: Introductionmentioning

confidence: 99%

“…[16][17][18][19] Mental disorders show high rates of co-occurring symptoms. 3 Therefore, we postulate that the simultaneous administration of a few single-disorder tools would identify not only the specific disorder of that instrument but it would also identify general MEDs. For a bundled screening would be useful that the single-disorder screening tools include the more prevalent disorders or whose early detection is important in primary health care.…”

mentioning

confidence: 99%

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Specific mental disorder screening compilation may detect general mental disorders

Bolsoni

Moscovici

Marques

et al. 2018

Rev Bras Med Fam Comunidade

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Objective: To evaluate whether a short compilation of screening tools for specific disorders could identify Mental or Emotional Disorders (MEDs) in the general population. Methods: We selected validated screening tools for the most prevalent MEDs. In order to be selected, these tools should maintain the psychometric properties of the complete instrument with a reduced number of items. These instruments were: Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2), item 3 of the Alcohol Use Disorders Identification Test (AUDIT), and three items on the Adolescent Psychotic-Like Symptom Screener (APSS-3). We called this compilation of screening tools Mini Screening for Mental Disorders (Mini-SMD). The study was divided in two phases. Firstly, 545 subjects were interviewed with the Mini-SMD and COOP/WONCA-Feelings at their residences. Subsequently, subjects who had agreed to participate (230) were reinterviewed with Mini-SMD, COOP/WONCA-Feelings and MINI interview. Test-retest reliability was calculated by Intraclass Correlation Coefficient (ICC). Receiver operating characteristic (ROC) curves were generated for the analysis of discriminative validity. Concurrent validity was calculated by analyzing the correlation between Mini-SMD and COOP/WONCA-Feelings. Results: The joint administration of screening tools for specific disorders showed sensitivities that ranged from 0.76 to 0.88 and specificities from 0.67 to 0.85. The ICC value for the total score of Mini-SMD was 0.78. The area under the curve was 0.84, with a sensitivity of 0.74 and specificity of 0.76 (for a cutoff ≥ 4). Conclusion: This study showed that a short compilation of screening tools for specific disorders can detect MEDs in general population.

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Section: Scale-2 (Gad-2) El Elemento 3 Del Alcohol Use Disorders Idementioning

confidence: 99%

“…3 The advantage of compiling multiple disorders in the Mini-SMD is that it brings together evaluation items that are common in several MEDs (e.g., depression and anxiety).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Specific mental disorder screening compilation may detect general mental disorders

Bolsoni

Moscovici

Marques

et al. 2018

Rev Bras Med Fam Comunidade

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“…(3,4) The uptake rates of pediatric behavioral health screening, however, are very poor (~ 15%) and depend signi cantly on the state policy, primary care providers' training in behavioral health and reimbursement of screening services. (5)(6)(7)(8)At patient level, lack of awareness, race/ethnicity, socioeconomic status and insurance status have been identi ed as the strong predictors of receiving general health screening services. (9,10) The association of geographic access to primary care providers (PCPs) with pediatric behavior disorder screening is yet to be examined.…”

Section: Introductionmentioning

confidence: 99%

Impact of Geographic Access to Primary Care provider on Pediatric Behavioral Health Screening

Upadhyay

Aparasu

Rowan³

et al. 2020

Preprint

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Objective : To assess the impact of geographic access to primary care providers (PCPs) on the receipt of behavioral disorder screening among children and adolescents from different racial/ethnic groups. Data Sources/Study Setting: The primary data source was 2013-2016 administrative claims data from a large pediatric Medicaid Managed Care Plan linked to the US Census data and the National Provider Identifier (NPI) Registry. Study Design: The study was a retrospective cohort design which was conducted using data obtained from multiple sources. Data Collection/Extraction Methods : Geographic access was measured as one way travel distance to the nearest PCP estimated based on google map, and the PCP density per 10,000 population within a 10-mile travel radius from the population weighted centroid of each individual’s zip code. Multivariate logistic regression was conducted to examine the association between the geographic access measures and the likelihood of receiving behavioral disorder screening within each racial/ethnic group. Principal Findings : Behavioral disorder screening rate was 12.6% among 457,870 children and adolescents who met the inclusion criteria. Multivariable analyses revealed that the travel distance to the nearest PCP was negatively associated with the screening uptake among Hispanics (10-20 vs. 0-10 miles: OR=0.78, 95%CI [0.71-0.86]; 20-30 vs. 0-10 miles: OR=0.35, 95%CI [0.23-0.54]). Similar effects associated with the travel distance were not observed in Blacks and Whites. Among those having access to ≥1 PCP within 10 miles of travel distance, the increase in PCP density had a greater positive impact on the receipt of behavioral disorder screening in minorities than that in Whites. Conclusion : Minorities, especially Hispanics, were more sensitive than Whites to the geographic access barriers to PCPs for pediatric behavioral disorder screening.

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Anxiety Disorders

Szuhany

Simon

2022

JAMA

128

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ImportanceAnxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning.ObservationsAnxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder–7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% to 97%). Providing information about symptoms, diagnosis, and evidence-based treatments is a first step in helping patients with anxiety. First-line treatments include pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs, eg, sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, eg, venlafaxine extended release) remain first-line pharmacotherapy for generalized anxiety disorder, social anxiety disorder, and panic disorder. Meta-analyses suggest that SSRIs and SNRIs are associated with small to medium effect sizes compared with placebo (eg, generalized anxiety disorder: standardized mean difference [SMD], −0.55 [95% CI, −0.64 to −0.46]; social anxiety disorder: SMD, −0.67 [95% CI, −0.76 to −0.58]; panic disorder: SMD, −0.30 [95% CI, −0.37 to −0.23]). Cognitive behavioral therapy is the psychotherapy with the most evidence of efficacy for anxiety disorders compared with psychological or pill placebo (eg, generalized anxiety disorder: Hedges g = 1.01 [large effect size] [95% CI, 0.44 to 1.57]; social anxiety disorder: Hedges g = 0.41 [small to medium effect] [95% CI, 0.25 to 0.57]; panic disorder: Hedges g = 0.39 [small to medium effect[ [95% CI, 0.12 to 0.65]), including in primary care. When selecting treatment, clinicians should consider patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care.Conclusions and RelevanceAnxiety disorders affect approximately 34% of adults during their lifetime in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.

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Screening for Behavioral Health Conditions in Primary Care Settings: A Systematic Review of the Literature

Cited by 113 publications

References 71 publications

Specific mental disorder screening compilation may detect general mental disorders

Specific mental disorder screening compilation may detect general mental disorders

Impact of Geographic Access to Primary Care provider on Pediatric Behavioral Health Screening

Anxiety Disorders

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