Novel Health Information Technology to Aid Provider Recognition and Treatment of Major Depressive Disorder and Posttraumatic Stress Disorder in Primary Care

Abstract

Background: Millions of traumatized refugees worldwide have resettled in the United States. For one of the largest, the Cambodian community, having their mental health needs met has been a continuing challenge. A multicomponent health information technology screening tool was designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting. Methods: In a clustered randomized controlled trial, 18 primary care providers were randomized to receive access to a multicomponent health information technology mental health screening intervention, or to a minimal intervention control group; 390 Cambodian American patients empaneled to participating providers were assigned to the providers’ randomized group. Results: Electronic screening revealed that 65% of patients screened positive for depression and 34% screened positive for PTSD. Multilevel mixed effects logistic models, accounting for clustering structure, indicated that providers in the intervention were more likely to diagnose depression [odds ratio (OR), 6.5; 95% confidence interval (CI), 1.48–28.79; P=0.013] and PTSD (OR, 23.3; 95% CI, 2.99–151.62; P=0.002) among those diagnosed during screening, relative to the control group. Providers in the intervention were more likely to provide evidence-based guideline (OR, 4.02; 95% CI, 1.01–16.06; P=0.049) and trauma-informed (OR, 15.8; 95% CI, 3.47–71.6; P<0.001) care in unadjusted models, relative to the control group. Guideline care, but not trauma-informed care, was associated with decreased depression at 12 weeks in both study groups (P=0.003), and neither was associated with PTSD outcomes at 12 weeks. Conclusions: This innovative approach offers the potential for training primary care providers to diagnose and treat traumatized patients, the majority of whom seek mental health care in primary care (ClinicalTrials.gov number, NCT03191929).

Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review

“…In the study by Ahmad et al [50], an interactive computer-assisted client assessment survey (iCCAS) tool improved mental health consultations compared to usual care. Similarly, the study by Sorkin et al [65] found that a multicomponent health information technology mental health screening intervention helped primary care providers with diagnosing and providing evidence-informed care to Cambodian refugees. In terms of integrating mental health care into primary care, the study by Northwood et al [60] conducted a pragmatic RCT on adult Karen refugees in two primary care clinics.…”

“…However, many primary care providers do not discuss trauma histories with patients or feel unprepared to do so [78,79]. Future studies should assess trauma-informed care for primary care providers [65,80]. For vulnerable populations, socioeconomic stressors are closely connected to their mental health and can prevent them from benefiting from mental health treatment [54].…”

A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

“…The resulting 19 articles, with two conference abstracts, 21,22 were examined in-depth to determine the participants, mode and length of training, topics, and evaluation methods and results. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] We identified 17 different curricula in the 19 articles included for final analysis. The two articles by Green et al discuss the same curriculum, but evaluate different outcomes.…”

“…Trainings were taught by a mixture of health professionals including TIC experts, clinical psychologists, social workers, physicians, and nurses. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (Continued on next page)…”

“…[23][24][25][26][27][28][29][30][31] Two educational curricula were adapted from prior curricula, while the remainder were created from a variety of sources, including Substance Abuse and Mental Health Services Administration principles, 4 the American Academy of Pediatrics Trauma Toolbox for Primary Care, 40 guidelines from the American Psychological Association, 41 evidence-based literature, and expert feedback. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Bursch et al adapted the "Families OverComing Under Stress" resiliency training program (a strength-based, trauma-informed training program for deployed military personnel) for use with medical residents. 25 Green et al adapted the Risking Connection curriculum (a strength-based training program for helping people who have been hurt in interpersonal relationships, previously used in mental health, congregate care, faith-based, and medical facilities) for use with primary care residents, advanced practice providers, and physicians.…”