IMPACT OF SCREENING FOR MENTAL-HEALTH CONCERNS ON HEALTH-SERVICE UTILIZATION AND FUNCTIONAL STATUS IN PRIMARY-CARE PATIENTS

Background: Mental health concerns are common in primary care patients and are often inadequately addressed by primary care physicians. Obje ctive: To assess the impact of screening for mental disorders in inter nal medicine patients. Methods: Randomly selected patients (n=358) vis iting physicians in 2 firms of an urban academic internal medicine cli nic were screened for mental disorders using the 16-item Symptom-Drive n Diagnostic System for Primary Care (Upjohn Co, Kalamazoo, Mich) firs t-stage screening questionnaire. In the experimental firm, physicians received the screening results and then administered second-stage diag nostic modules. In the control firm, physicians were not notified of t he results of the screening questionnaire. Baseline and 3-month functi on were assessed using the SF-36 Health Survey, the Zung Self-Rating D epression Scale, and the Sheehan Patient-Rated Anxiety Scale. Patient satisfaction and health care utilization were also assessed by questio nnaire at baseline and after 3 months. Results: Patients screening pos itively for any mental disorder (n=238, 66.5%) had markedly lower base line functional status than those screening negatively (P<.05 on all 8 SF-36 Health Survey subscales) and more total (+/-SD) outpatient visi ts over 3 months (4.5+/-5.5 vs 2.5+/-2.6 visits, P=.001). Among patien ts who screened positively, functional outcomes and patient satisfacti on were similar in experimental and control groups; mean utilization ( +/-SD) was lower in the experimental group (3.7+/-3.9 vs 5.3+/-6.7 tot al outpatient visits at 3 months, P=.06; 0.9+/-1.5 vs 2.1+/-3.7 visits to non-mental health specialists, P=.003; 0.2+/-0.5 vs 0.4+/-0.9 x-ra y films per patient, P=.01). The follow-up response rate was 286 (79.9 %) of 358 patients. Conclusions: The 16-item first-stage Symptom-Drive n Diagnostic System for Primary Care screening questionnaire for menta l disorders call identify primary care patients who are at risk for lo wer functional status and higher utilization. Use of the Symptom-Drive n Diagnostic System for Primary Care second-stage diagnostic modules i n patients who screened positively for mental disorders was associated with lower utilization rates but had no impact on functional outcome or patient satisfaction after 3 months.