A new study in General Hospital Psychiatry finds patients visiting the hospital for a variety of ailments can be easily screened for depression and anxiety as they wait for care, information that can then be sent immediately to their doctor to address.
Researchers at King's College London University piloted an electronic questionnaire with patients in six specialty services in three London hospitals: rheumatology, limb reconstruction, hepatitis C, psoriasis, congenital heart disease and chronic pain. Patients were asked to complete questions on a wireless touch-screen device while in the waiting room. The test included questions about depression and anxiety, as well as physical health outcomes and health behaviors. Results were immediately transmitted to the health care provider, who could then discuss them with the patient during the visit.
"The system is extremely effective at providing clinicians with real-time information about their patients," said Faith Matcham, a doctoral student at the Institute of Psychiatry at King's College, London. "It makes effective use of waiting room time, and provides useful, usable information in a format which is easy for non-mental health professionals to interpret and act upon."
The study was done primarily to test the use of the device, which is part of a London-based initiative to facilitate integrated care, but also allowed researchers to evaluate the prevalence of depression and anxiety. Prevalence of probable depression ranged from 6.6 percent in patients with congenital heart disease to 60.9 percent in patients with chronic pain. Prevalence of probable anxiety ranged from 11.4 percent in patients with congenital heart disease to 25.1 percent in rheumatology patients.
The different rates prevalence of possible depression and anxiety underscores the complex interaction between physical and mental health, Matcham added. "It really highlighted to us that no two services could be handled in the same way; each is seeing a different type of patient, with different needs, in very different environments."
Screening for depression and anxiety in general medicine is important because mental health issues factor into cardiovascular disease and other conditions, said Philip R. Muskin, M.D., professor of psychiatry at Columbia University Medical Center in New York City and chair of the American Psychiatric Association's scientific program committee. Several states, including New York, are pushing for more mental health screening as part of regular health care, he noted.
This system used at the London hospitals appears to be effective because patients accepted it, Muskin said. "It engages the people who are most important, the patient and doctor, with an instrument that can tell them that something is going on."
- L. Rayner, F. Matcham, J. Hutton, C. Stringer, J. Dobson, S. Steer, M. Hotopf. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. General Hospital Psychiatry, 2013; DOI: 10.1016/j.genhosppsych.2013.12.004
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