1992 Articles and Preprints

Psychological Management In Routine Family Practice

Olfson, Mark; Weissman, Myrna M.; Leon, Andrew C; Higgins, Edmund S; Barrett, James E; Blacklow, Robert S

Background: Little is known about the provision of psychological management in routine primary care. This study examines patient demographic and clinical characteristics which predict who receives psychological management at three university affiliated family medicine practices.

Methods: Primary care patients (N=937) completed a mental health screening form immediately prior to their medical visit. Results were withheld from their physicians (N=7). Following the visit, the physicians were asked to classify the range of psychological interventions they used to manage their patients’ emotional problems during the visit. A structured psychiatric diagnostic interview was subsequently administered to a subgroup of the patients (N=288).

Results: At least one psychological intervention was provided to nearly a quarter (24.1%) of the patients. The interventions included listening to the patient’s emotional problems (22.4%), providing advice (19.0%), discussing the patient’s mental disorder diagnosis (11.4%), and providing individual counseling (8.4%) or family counseling (0.6%). Two thirds (66.7%) of the patients who reported that their emotional health was poor received at least one of these psychological interventions. In a multivariate model, the likelihood of receiving a psychological intervention was increased for patients who were separated or divorced; between 45 and 59 years of age; had less than a college education; received disability payments; reported poor emotional health; or had a positive SDDS-PC screen for panic disorder, major depressive disorder, or obsessive-compulsive disorder.

Conclusion: Primary care physicians may be far more extensively involved in providing psychological interventions than is commonly assumed. Individual determinants of who receives psychological interventions included measures of clinical need and predisposing sociodemographic characteristics.