Improving the Detection of Drug Abuse, Alcohol Abuse, and Depression in Community Health Centers

Up to 35 percent of primary care patients suffer from substance abuse or mental disorders, and most of these patients receive care from general medical professionals rather than mental health specialists. Accumulating evidence suggests that primary care physicians often fail to recognize, diagnose, and treat their patients with mental and substance use disorders; only about 5 percent of primary care visits result in a mental or substance use diagnosis. The goals of this project were to evaluate the feasibility of screening for drug abuse, alcohol abuse, and major depression at two federally funded urban Community/Migrant Health Centers (C/MHCs), in Newark, New Jersey, and Bronx, New York, and to examine the effects of a clinical tool designed to guide primary care clinicians in the identification and treatment of substance use and depression, assess provider perceptions of the screening form, and determine the concordance between provider and patient reports of assessment and management.

[1]  Jacob Cohen A Coefficient of Agreement for Nominal Scales , 1960 .

[2]  E L Gullick,et al.  Appropriateness of drugs prescribed by primary care physicians for depressed outpatients. , 1979, Journal of affective disorders.

[3]  W. Clark Alcoholism: blocks to diagnosis and treatment. , 1981, The American journal of medicine.

[4]  P. Cohen,et al.  The clinician's illusion. , 1984, Archives of general psychiatry.

[5]  M. Ganguli,et al.  Assessing depression in primary medical and psychiatric practices. , 1985, Archives of general psychiatry.

[6]  D H Freeman,et al.  Depressive symptoms in relation to physical health and functioning in the elderly. , 1986, American journal of epidemiology.

[7]  R. W. Turner,et al.  Anxiety and depression in a primary care clinic. Comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessments. , 1987, Archives of general psychiatry.

[8]  M. Weissman,et al.  Factors Affecting the Utilization of Specialty and General Medical Mental Health Services , 1988, Medical care.

[9]  M. Aronson,et al.  Prevalence and recognition of alcohol abuse in a primary care population. , 1988, The American journal of medicine.

[10]  Morbidity at an Amsterdam inner city clinic in relation to drug use. , 1989, Family practice.

[11]  A. Freeman,et al.  The Treatment of Depression , 1990 .

[12]  S B Soumerai,et al.  Principles of educational outreach ('academic detailing') to improve clinical decision making. , 1990, JAMA.

[13]  E. Perez-stable,et al.  Depression in medical outpatients. Underrecognition and misdiagnosis. , 1990, Archives of internal medicine.

[14]  L. George,et al.  Depression, disability days, and days lost from work in a prospective epidemiologic survey. , 1990, JAMA.

[15]  J. Janosky,et al.  Depressive Symptomatology and Medical Co-Morbidity in a Primary Care Clinic , 1990, International journal of psychiatry in medicine.

[16]  S. Schwartz,et al.  Socioeconomic status and psychiatric disorders , 1990 .

[17]  Opinion leaders vs audit feedback to implement practice guidelines. , 1991, JAMA.

[18]  P E Shrout,et al.  Socioeconomic status and psychiatric disorders: the causation-selection issue. , 1992, Science.

[19]  G. Klerman,et al.  The treatment of depression: prescribing practices of primary care physicians and psychiatrists. , 1992, The Journal of family practice.

[20]  X Tonesk,et al.  Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. , 1992, QRB. Quality review bulletin.

[21]  M. Weissman,et al.  Service utilization and social morbidity associated with depressive symptoms in the community. , 1992, JAMA.

[22]  R. L. Thomas,et al.  A six year longitudinal study of the occupational consequences of drinking over "safe limits" of alcohol. , 1992, British journal of industrial medicine.

[23]  R. Bland Psychiatric Disorders in America: The Epidemiologic Catchment Area Study , 1992 .

[24]  R. Botelho,et al.  Dealing with substance misuse, abuse, and dependency. , 1993, Primary care.

[25]  D. Regier,et al.  Use of services by persons with mental and addictive disorders. Findings from the National Institute of Mental Health Epidemiologic Catchment Area Program. , 1993, Archives of general psychiatry.

[26]  P. Anderson Management of alcohol problems: the role of the general practitioner. , 1993, Alcohol and alcoholism.

[27]  L. George,et al.  One‐month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study , 1993, Acta psychiatrica Scandinavica.

[28]  M. Liebowitz,et al.  The DSM-IV field trial for mixed anxiety-depression. , 1994, The American journal of psychiatry.

[29]  R. Kessler,et al.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. , 1994, Archives of general psychiatry.

[30]  J Ormel,et al.  Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. , 1994, JAMA.

[31]  C. O'brien Treatment of alcoholism as a chronic disorder. , 1994, Alcohol.

[32]  G. R. Kelman,et al.  The relationships between high-risk and problem drinking and the occurrence of work injuries and related absences. , 1994, Journal of studies on alcohol.

[33]  J. Anthony,et al.  Filters on the pathway to mental health care, II. Sociodemographic factors , 1995, Psychological Medicine.

[34]  M. Olfson,et al.  Brief diagnostic interviews (SDDS-PC) for multiple mental disorders in primary care. A pilot study. , 1995, Archives of family medicine.

[35]  P. Roy-Byrne Prevalence of Mental Disorders in Primary Care , 1995 .

[36]  M. Olfson,et al.  Prevalence of mental disorders in primary care. Implications for screening. , 1995, Archives of family medicine.

[37]  M. Olfson,et al.  Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. , 1995, Archives of family medicine.

[38]  J. Vessey,et al.  Patterns of mental health service utilization. , 1996, Archives of general psychiatry.

[39]  P. May,et al.  PRIME-MD: Its Utility in Detecting Mental Disorders in American Indians , 1997, International journal of psychiatry in medicine.

[40]  M. Olfson,et al.  Mental disorders and disability among patients in a primary care group practice. , 1997, The American journal of psychiatry.

[41]  G. Dunn,et al.  Mental health in primary care , 1997, British Journal of Psychiatry.

[42]  J. Miranda,et al.  Unmet mental health needs of women in public-sector gynecologic clinics. , 1998, American journal of obstetrics and gynecology.

[43]  Shan Cretin,et al.  Implementing clinical practice guidelines , 1999 .

[44]  M. Stein,et al.  Depression in a primary care clinic: the prevalence and impact of an unrecognized disorder. , 1999, Journal of affective disorders.

[45]  M. Olfson,et al.  Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. , 2000, Archives of family medicine.

[46]  C. Blacker,et al.  The prevalence and treatment of depression in general practice , 2004, Psychopharmacology.

[47]  S. Hoppe,et al.  Depression and anxiety among Mexican Americans in a family health center , 1989, Social Psychiatry and Psychiatric Epidemiology.