Recognition of anxiety, depression, and PTSD in patients with COPD and CHF: Who gets missed?

Gen Hosp Psychiatry. 2017 Jul:47:61-67. doi: 10.1016/j.genhosppsych.2017.05.004. Epub 2017 May 12.

Abstract

Objective: This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans.

Method: Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and health-related quality of life (QOL).

Results: Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (≥1 MH encounter or psychiatric medications). Greater depression (p=0.047) and adaptive coping (p=0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p<0.001), higher internal locus of control (p=0.037), and poorer physical health-related QOL (p=0.014) were associated with greater likelihood of MH service use.

Discussion: Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL.

Keywords: Anxiety; Depression; Diagnosis; Primary care; Recognition.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adaptation, Psychological / physiology
  • Adult
  • Aged
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology*
  • Comorbidity
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology*
  • Electronic Health Records / statistics & numerical data
  • Female
  • Heart Failure / epidemiology*
  • Humans
  • Internal-External Control
  • Male
  • Mental Health Services / statistics & numerical data
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Quality of Life
  • Retrospective Studies
  • Self Efficacy
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Veterans / statistics & numerical data*