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Screening for mental illness in primary care clinics
Linda S Kahn1, Uriel Halbreich, Michael S Bloom
1Department of Psychiatry, State University of New York at Buffalo School of Medicine, USA.
International Journal of Psychiatry in Medicine
|April 14, 2005
Summary
Physician diagnosis of mental illness in primary care is significantly lacking, even with patient self-report checklists. The Problem Oriented Patient Report (POPR) identified numerous potential mental health conditions missed by clinicians.
Area of Science:
- Public Health
- Primary Care Medicine
- Mental Health Services Research
Background:
- Inner-city outpatient clinics serve diverse populations with high mental disorder prevalence.
- Accurate diagnosis of mental illness in primary care is crucial for timely intervention and treatment.
- Existing diagnostic methods may not adequately capture the full spectrum of mental health conditions in primary care settings.
Purpose of the Study:
- To determine the prevalence of mental disorders among patients in inner-city primary care clinics.
- To evaluate the effectiveness of a patient self-report checklist in improving mental illness diagnosis within primary care.
Main Methods:
- The Problem Oriented Patient Report (POPR), a patient self-report tool, was administered to 362 outpatients at two urban primary care clinics.
- POPR results were reviewed for potential mental illness diagnoses, with a focus on identification by physicians during patient visits.
- Clinical charts were subsequently reviewed to ascertain the rate of new mental illness diagnoses made by physicians.
Main Results:
- The POPR identified potential mental illnesses in 148 out of 362 patients (40.9%).
- A striking 98% of these potential diagnoses were missed by the reviewing physicians.
- Physicians independently made only five new mental illness diagnoses, all in continuing care patients.
Conclusions:
- Physicians in these inner-city primary care clinics demonstrated a significant failure to diagnose mental illnesses, even when provided with patient self-report data.
- Factors such as staff attitudes and patient/physician responses may influence diagnostic outcomes.
- Despite potential false positives from the POPR, the low rate of physician-identified diagnoses highlights a critical gap in mental healthcare delivery.