Furthermore, research has generated ever-increasing evidence that poor psychological health is inextricably linked to physical illness (Pomerantz et al., 2009 Weiss et al., 2009). Patients often experience a host of barriers, for example low income or limited insurance coverage, that prevent them from obtaining proper mental health treatment (Kohn et al., 2004 Rowan et al., 2013). This urgency is undoubtedly associated with patient access to care and the complex relationship between mental and physical health. The need for mental health screening has become even more urgent in the last decade (Faghri et al., 2010 Kroenke & Unutzer, 2017 Weisberg et al., 2007). ( 1978) insightfully recognized that primary care operated as the de facto mental health service for most patients (see also Kessler, 2005, 2005a, b, c). More than three decades ago, Regler et al. Primary care providers must often address a wide range of mental health concerns in their practices. In 2016, more than half (54.5%) of 883 million physician office visits in the USA involved PCPs (Rui & Okeyode, 2016) with many visits including mental health issues, such as depression and anxiety (Ashman et al., 2019 Olfson, 2016 Olfson et al., 1995). The majority of primary care practices specialize in family medicine, followed by general internal medicine and pediatrics (Petterson et al., 2018). From a multidisciplinary perspective, one valuable approach involves primary care physicians (PCPs), who may integrate mental health screens into their practices (Shedler et al., 2000). For patients, both access and cost barriers can substantially undermine the treatment process, that is, if they can afford to seek treatment at all (Andrade et al., 2014 Rowan et al., 2013 Russell, 2010).Ĭlearly, the prevalence, severity, and effects of mental disorders (e.g., Kroenke et al., 2007) underscore the compelling need to improve clinical methods for screening and assessment. Financially, treatment costs associated with inpatient hospitalizations for serious mental disorders can exceed $5000 per week (Stensland et al., 2012). The effects of mental disorders are far-reaching and marked with life-changing events, such as at greater risk for employment termination (Nelson & Kim, 2011 Olesen et al., 2013), victimization (Swartz & Bhattacharya, 2017), and suicide attempts (Brådvik, 2018). Moreover, lifetime prevalences for four diagnostic categories are troubling: 28.8% for anxiety disorders, 24.8% for impulse control disorders, 20.8% for mood disorders, and 14.6% for substance use disorders (Kessler et al., 2005b). For example, despite its low prevalence, 82.9% of persons with bipolar disorders were classified at the highest level of severity (Kessler et al., 2005a). Diagnostic severity with its functional impairment must also be considered. The National Institute of Mental Health (NIMH, 2020) identified over 46 million adults that were diagnosed with at least one serious mental disorder. According to World Health Organization (WHO), most persons with mental disorders, including those in the USA, remain untreated in medical and psychiatric settings (Wang et al., 2007). Globally, mental disorders continue to increase with an estimated 264 million people functionally impaired by depression alone (James et al., 2018). In general, the CMFC effectively identified provisional diagnoses, impairment, and potential suicidality. Importantly, the suicide screen identified all patients with suicide plans and three-fourths with ideation. Bipolar Disorder posed the most challenges at both tiers. About two-thirds of provisional SAM diagnoses were confirmed with high specificities. The CMFC Initial Screen evidenced strong sensitivity, identifying with very few missing diagnoses. Concerningly, many patients were unaware of their current mental disorders and comorbidities. With 234 patients from five independent PCP offices, diagnostic accuracy was tested with the SCID-5-RV as the external criterion. The eight-item Initial Screen assesses possible symptoms, whereas SAM modules establish provisional diagnoses and areas of clinical concern. The current study examined the Connected Mind Fast Check (CMFC), a two-tiered electronic screen, assessing six common mental disorders. Primary care physicians (PCPs) often daily address diagnoses and treatment of mental disorders in their practices.
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