Mood Disorder Recognition in Rural Primary Care:
Is it Depression or Bipolar Disorder ?
APPLIED PSYCHOLOGY LABORATORY
East Tennessee State University
http://www.etsu.edu/apl/
Johnson City, Tennessee
Druery, Ryne C., Miesner, Michael T., & Dula, Chris S.
INTRODUCTION
RESULTS
DISCUSSION
• It’s been known for over a decade that patients with mental
illnesses seek no mental health care, but approximately 80% of
those patients will receive treatment from a primary care
physician (Strosahl, 1998).
Data were subjected to a Chi Square. Mental Health Referrals
differed as a function of mood disorders , X2 (2)=26.52, p <.001
• The findings of this pilot study concerns the amount of mood
disorders noted, and additionally, how these mood disorders
were handled.
• In a large multi-site study, Lowe et al. (2008) found that within
primary care facilities, patients reported there were over 50% of
an overlap occurring between anxiety, depression, and
somatization. However, each of these disorders had
prevalence rates of approximately 10% in primary care
independently.
Mood Disorder Noted in Chart vs. Mental Health Referral
None
Bipolar
No Referral
61
3
Depression
Referral
1
4
28
• During chart review, it was found that when a possible serious
mood disorder was noted often no record of a referral to a
mental health expert was made by a PCP.
• It should also be noted that of the patients referred to a mental
health expert all were already being treated with medicine
prescribed by their PCP.
3
70
60
• It is possible to conclude that interventions in primary care is
necessary to help physicians detect these disorders and treat
them more effectively.
50
• Research has indicated that whereas only one third of patients
in primary care are properly diagnosed as depressed, up to
50% of the potentially depressed patients may be incorrectly
diagnosed (Budman & Butler, 1997; Munoz, Hollon, McGrath,
Rhen, & VandenBos, 1994).
• Though a large sample (72%) of the positive screeners sought
professional help for the symptoms of bipolar disorder, only 9 of
these patients (8.4%) were actually diagnosed with bipolar
disorder (Das et al., 2005) .
40
30
• H2: It was hypothesized that when depression and bipolar
disorder is treated in primary care, it is done so in a
pharmacological manner using Antipsychotics, Selective
Serotonin Reuptake Inhibitors (SSRI) or Tricyclic
Antidepressants (TCA).
METHOD
• Participants : 100 medical charts were reviewed at a rural
family medicine clinic.
• Method: Data was collected using 8 undergraduates trained to
review medical charts in the integrated primary care practice.
Information that was obtained relative to mood disorders was
the treating physician, first notation of depression and bipolar
disorder, method of treatment, any medications which could be
used (including off label uses) to treat the mood disorder, and if
a mental health referral occurred.
LIMITATIONS
20
• Data was only collected from one primary care site.
10
• There was no way to verify that the medical charts were
complete in regards to the patients medical history.
0
None
Bipolar
Depression
• The scope of this project limited us from accurately
gathering the type of mood disorder as well as the
severity of the mood disorder due to medical chart review
nature.
Mood Disorders and Treatments Given
Treatment
TCA's
HYPOTHESES
• H1: It was hypothesized that depression and bipolar disorder
are commonly recognized in primary care, but often not a
focus on treatment or referrals.
No
Yes
SSRI's
Antipsychotics
None
4
6
1
Bipolar
1
3
3
Depression
5
16
5
18
16
14
12
10
8
6
4
2
0
IMPLICATIONS & FUTURE DIRECTIONS
•
Future studies are planned in which multiple interventions
will be tested.
• These interventions will look to educate physicians about
None
depression and bipolar disorders by providing brief
Bipolar
assessment tools, and strategies on how to refer their
Depression
patients with mood disorders to mental health providers in
Note: Some
integrated
primary
care.
patients may be
represented
more than once
due to multiple
treatments or
misdiagnosis
SSRI's
TCA's
Antipsychotics
• These future studies and interventions will also research
on ways PCP’s can reduce the negative stigma the
general public has in regards to seeing a mental health
expert.
REFERENCES
Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems & Health, 21,
121-134.
Lowe, B., Spitzer, R. L., Williams, J. B., Mussell, M., Schellberg, D., & Kroenke, K. (2008). Depression, anxiety and
somatization in primary care: Syndrome overlap and functional impairment.
Budman, S.H. & Butler, S.F. (1997). The Lily family depression project: Primary care prevention in
Muñoz, R. F., Hollon, S. D., McGrath, E., Rehm, L. P., & VandenBos, G. R. (1994). On the AHCPR Depression in
action. In N.A. Cummings, J.L. Cummings, J.N. Johnson & N.J. Baker (Eds.), Behavioral Health in
Primary Care guidelines: Further considerations for practitioners. American Psychologist, 49, 42-61.
primary care: A guide for clinical integration. (pp 219-238). Madison, Ct: Psychosocial
Press/International Universities Press, Inc.
Das, A. K., Olfson, M., Gameroff, M. J., Pilowsky, D. J., Blanco, C., Feder, A., et al. (2005). Screening
for bipolar disorder in a primary care practice. JAMA : the journal of the American Medical
Association, 293, 956-63.
Strosahl, K. (1998). Integrating behavioral health and primary care services: The primary mental health care model. In
A. Blount (Ed.), Integrated primary care: The future of medical and mental health collaboration.(pp 139-166). New
York: W.W. Norton & Co., Inc.
CONTACT: Ryne_Druery@yahoo.com or Chris S. Dula, dulac@etsu.edu