scholarly journals Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018323 ◽  
Author(s):  
Anders Prior ◽  
Mogens Vestergaard ◽  
Karen Kjær Larsen ◽  
Morten Fenger-Grøn
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Perceived Stress ◽  
Chronic Care ◽  
Population Based ◽  
Related Services ◽  
Out Of Hours ◽  
Care Services ◽  
Health Related ◽  
Health Registers

ObjectivesMental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental–physical multimorbidity.DesignPopulation-based cohort study.SettingPrimary healthcare in Denmark.Participants118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.Outcome measuresGeneral daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.ResultsPerceived stress levels were associated with primary care activity in a dose–response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.ConclusionPersons with high stress levels generally had higher use of primary healthcare, 4–6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

2020 ◽  
pp. 009121742097799
Author(s):  
Krista Schultz ◽  
Sharan Sandhu ◽  
David Kealy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Care Physician ◽  
Population Based ◽  
Borderline Personality ◽  
Care Physician ◽  
Cross Sectional

Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

scholarly journals Screening Neurocognitive Disorders in Primary Care Services: The Quick Mild Cognitive Impairment Approach

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 158-158
Author(s):  
Constanca Paul ◽  
Susana Sousa ◽  
Pedro Santos ◽  
Rónán O’Caoimh ◽  
William Molloy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Community Sample ◽  
Neurocognitive Disorders ◽  
Cognitive Status ◽  
Health Concerns ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Concerns

Abstract Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.

Variation in Utilization of Health Care Services for Rural VA Enrollees With Mental Health-Related Diagnoses

2015 ◽  
Vol 31 (3) ◽  
pp. 244-253 ◽  
Author(s):  
Christopher E. Johnson ◽  
Ruth L. Bush ◽  
Jeffrey Harman ◽  
Jane Bolin ◽  
Gina Evans Hudnall ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Services ◽  
Care Services ◽  
Health Related

scholarly journals Pathways to Mental Health–Related Treatment Among Caregiving Spouses

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 358-358
Author(s):  
Hyojin Choi ◽  
Kristin Litzelman ◽  
Molly Maher ◽  
Autumn Harnish
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Healthcare ◽  
Health Condition ◽  
Future Research ◽  
Provider Type ◽  
Hospital Emergency Room ◽  
Health Related ◽  
Nationally Representative

Abstract Spouses of cancer survivors are 33% less likely to receive guideline-concordant depression treatment than other married adults. However, depression is only one of many manifestations of psychological distress for caregivers. This exploratory study sought to assess the paths by which caregivers access mental health-related treatment. Using nationally representative data from the Medical Expenditures Panel Survey, we assessed the proportion of caregivers who received a mental health-related prescription or psychotherapy visit across care settings (office based versus outpatient hospital, emergency room, or inpatient visit), provider type (psychiatric, primary care, other specialty, or other), and visit purpose (regular checkup, diagnosis and treatment, follow-up, psychotherapy, other). In addition, we assessed the health condition(s) associated with the treatment. The findings indicate that a plurality of caregivers accessed mental health-related treatment through an office-based visit (90%) with a primary care provider (47%). A minority accessed this care through a psychologist or psychiatrist (11%) or a physician with another specialty (12%) or other provider types. Nearly a third accessed treatment as part of a regular check-up (32%). These patterns did not differ from the general population after controlling for sociodemographic characteristics. Interestingly, mental health-related treatments were associated with a mental health diagnosis in only a minority of caregivers. The findings confirm the importance of regular primary care as a door way to mental healthcare, and highlight the range of potential paths to care. Future research will examine the correlates of accessing care across path types.

scholarly journals Sex-specific differences in prevalence and in the factors associated to the search for health services in a population based epidemiological study

2014 ◽  
Vol 17 (2) ◽  
pp. 323-340 ◽  
Author(s):  
Suzana Alves de Moraes ◽  
Daniele Almeida Lopes ◽  
Isabel Cristina Martins de Freitas
Keyword(s):  
Epidemiological Study ◽  
Associated Factors ◽  
Access To Health Care ◽  
Health Care Services ◽  
Economic Indicator ◽  
Population Based ◽  
Cross Sectional ◽  
Women Health ◽  
Care Services ◽  
Health Related

Objectives: To identify the access to health care services and associated factors in adults living in the city of Ribeirão Preto, São Paulo, Brazil, in 2007. Methods: A cross-sectional population-based epidemiological study with a sample developed in three stages. The variability introduced in the third sampling fraction was corrected by the attribution of weights, resulting in a sample of 2,471 participants. The outcome prevalence was estimated according to socio-demographic, behavioral and health-related variables. In order to identify associated factors, the regression of Poisson was used, obtaining crude and adjusted prevalence ratios. All estimates were calculated taking into account the effect of the sampling design. Results: The outcome prevalence increased according to the age, being higher in female individuals. A different set of variables remained in the final models, considering each gender separately. Among men, the monthly income > R$ 1,400.00; scores > 823.6 to the Economic Indicator of Ribeirão Preto (IERP) and daily average of sitting down time (154.4 - 240 min/day) constituted themselves into protective factors, whereas the increase of age and scholarship, hospitalization, diabetes and hypertension constituted risk factors for the use of the services. Among women, health self-reported as regular, hospitalization, diabetes and hypertension characterized factors positively associated to the outcome at matter. Conclusions: The results indicate the need for planning actions aimed at capturing male individuals, as well as the revaluation of detection and control of diabetes and hypertension programs, aimed at the primary prevention of terminal cardiovascular events.

scholarly journals Business as Un-usual: Access to mental health and primary care services for people with severe mental illness during the COVID-19 restrictions

2021 ◽  
Author(s):  
Elizabeth Newbronner ◽  
Panagiotis Spanakis ◽  
Ruth Wadman ◽  
Suzanne Crosland ◽  
Paul Heron ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Support ◽  
Health Support

Aims: To explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services. Materials and Methods: A representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyse the quantitative data. The free text responses were analysed thematically. Results: 367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it; acceptability was influenced by several factors. Participants were more likely to be satisfied with support received when seen in person. Discussion: Although most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.

scholarly journals Patient engagement, autonomy, access to mental care services – the case for integrated care in Crete

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Petelos ◽  
M Papadakaki ◽  
C Lionis
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Rural Areas ◽  
Common Ground ◽  
Local Governance ◽  
Mental Health Disorders ◽  
Care Services ◽  
Interdisciplinary Approaches ◽  
Health And Social Care ◽  
Health Disorders

Abstract Access to comprehensive primary care (PC) services is imperative to address the complex biopsychosocial needs of patients with mental illness and their families, while it holds the potential to safeguard mental health and enhance resilience in communities. Integration of mental health and social care services in primary care has not yet been achieved, while access to such services for the mentally ill is still hindered by patient-, provider- and system-oriented barriers. Improving service integration, quality and access requires active engagement of patients and families in the design and planning of services. Interprofessional collaboration, interdisciplinary approaches and sound deliberative processes are only the start of initiating discussions to establish the needs of local communities. Mapping care paths, involving stakeholders and engaging in practice-based research are impeded by the organisation and design of care provision, including siloed processes and semantic ambiguity in establishing common ground. Academic centres ought to act as hubs for bringing together all actors, creating living labs and addressing the needs of people in urban and rural areas. The case study from Crete will focus on the following questions: What actions are needed to improve access of people with mental health disorders to PC services and how could PC mediate effective communication with mental health services?To what extent people with mental health disorders experience violence, abuse or discriminatory behaviour in PC?To what extent PC services recognize and facilitate autonomy, self-determination and inclusion of people with mental health disorders?To what extent stakeholders and PC services engage people with mental health disorders in decision making process and local governance?To what extent educational interventions for PC practitioners could result in the reduction of discriminatory behaviour and safeguard the dignity among people with mental health disorders?

scholarly journals Have associations between mental health and health related behaviours changed between 2005 and 2015? A population based cross-cohort study

2020 ◽  
Author(s):  
Suzanne H. Gage ◽  
Praveetha Patalay
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Cohort Study ◽  
Mental Health Problems ◽  
Weight Perception ◽  
Population Based ◽  
Parents And Children ◽  
Health Related ◽  
Avon Longitudinal Study ◽  
Over Time

AbstractBackgroundPoor adolescent mental health is a growing concern over recent decades with evidence of increasing internalising mental health problems corresponding with decrease in anti-social, smoking and alcohol behaviours. However, understanding whether and how the associations between mental health and health-related behaviours such as substance use, anti-social behaviour and obesity have changed over time is less well-understood.ObjectivesWe investigate whether the associations between different health-related outcomes in adolescence are stable or changing over time in two recent cohorts of adolescents born ten years apart.MethodData from two UK birth cohort studies, the Avon Longitudinal Study of Parents and Children (ALSPAC, born 1991-92, N=5627, 50.7% female) and Millennium Cohort Study (MCS, born 2000-1, N=11318, 50.6% female) at age 14 sweeps are used. The health outcomes of focus are depressive symptom score, substance use (alcohol, smoking, cannabis and other drugs), antisocial behaviours (assault, graffiti, vandalism, shoplifting and rowdy behaviour), weight (BMI), weight perception (perceive self as overweight) and sexual activity (had sexual intercourse).ResultsOur results suggest although directions of associations between mental-health and health-related behaviours (eg smoking) are similar over time, their strength across the distribution has changed. While smoking and alcohol use behaviours are decreasing in adolescents, those that endorse these behaviours in 2015 are more likely to have co-occurring mental-health and other problems than those born in 2005. Similarly, higher body mass index is more strongly associated with depressive symptoms in 2015.ConclusionsOur findings suggest that associations between these factors has changed over time, which has implications for public health and our understanding of the mechanisms underlying their observed associations in the population.

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