Severity of Mental Health Impairment and Trajectories of Improvement in an Integrated Primary Care Clinic

Objective: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up app...

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Bibliographic Details
Published in:Journal of consulting and clinical psychology 2012-06, Vol.80 (3), p.396-403
Main Authors: Bryan, Craig J, Corso, Meghan L, Corso, Kent A, Morrow, Chad E, Kanzler, Kathryn E, Ray-Sannerud, Bobbie
Format: Article
Language:English
Subjects:
Adult
Appointments
Biological and medical sciences
Clinical outcomes
Clinics
Correlation
Depression (Psychology)
Female
Health Services
Human
Humans
Integrated Services
Male
Medical sciences
Mental Disorders - diagnosis
Mental Disorders - therapy
Mental Health
Mental Health Services
Middle Aged
Miscellaneous
Outcomes of Treatment
Patients
Primary care
Primary Health Care
Prognosis
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychotherapies. Psychological and clinical counseling
Psychotherapy
Severity
Severity (Disorders)
Severity (of Disability)
Severity of Illness Index
Surveys and Questionnaires
Treatment Outcome
Treatment Outcomes
Treatments
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Summary:Objective: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments. Method: Data from 495 primary care patients (61.1% female, 60.7% Caucasian, 37.141 plus or minus 12.21 years of age) who completed the Behavioral Health Measure (Kopta & Lowry, 2002) at each primary care appointment were used for the analysis. Three separate models were constructed to identify clinical improvement in terms of number of appointments attended, baseline impairment severity level, and the interaction of these 2 variables. Results: The data showed that 71.5% of patients improved across appointments, 56.8% of which (40.5% of the entire sample) was clinically meaningful and reliable. Number of appointments and baseline severity of impairment significantly accounted for variability in clinical outcome, with trajectories of change varying across appointments as a function of baseline severity. Patients with more severe impairment at baseline improved faster than patients with less severe baseline impairment. Conclusions: Patients treated within an integrated primary care behavioral health service demonstrate significant improvements in clinical status, even those with the most severe levels of distress at baseline. (Contains 2 tables and 1 footnote.)
ISSN:0022-006X
1939-2117
DOI:10.1037/a0027726