title: Integrated care: treatment initiation following positive depression screens.
abstract: BACKGROUND
  Primary Care-Mental Health Integration (PC-MHI) may improve mental health services access and continuity of care.
  
  
  OBJECTIVE
  To assess whether receipt of integrated PC-MHI services on the date of an initial positive depression screen influences receipt of depression treatment among primary care (PC) patients in the Veterans Health Administration.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Thirty-six thousand, two hundred and sixty-three PC patients with positive depression screens between October 1, 2009 and September 30, 2010.
  
  
  METHODS
  Subjects were assessed for depression diagnosis and initiation of antidepressants or psychotherapy on the screening day, within 12 weeks, and within 6 months. Among individuals with PC encounters on the screening day, setting of services received that day was categorized as PC only, PC-MHI, or Specialty Mental Health (SMH). Using multivariable generalized estimating equations (GEE) logistic regression, we assessed likelihood of treatment initiation, adjusting for demographic and clinical measures, including depression screening score.
  
  
  RESULTS
  Patients who received same-day PC-MHI services were more likely to initiate psychotherapy (OR: 8.16; 95 % CI: 6.54-10.17) and antidepressant medications (OR: 2.33, 95 % CI: 2.10-2.58) within 12 weeks than were those who received only PC services on the screening day.
  
  
  CONCLUSIONS
  Receipt of same-day PC-MHI may facilitate timely receipt of depression treatment.
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Heath, New Haven, CT 06520-8034, USA. benjamin.szymanski@yale.edu
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Szymanski
authors.forename: Kipling M
authors.initials: KM
authors.lastname: Bohnert
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011613:Psychotherapy; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D058014:Veterans Health
chemical_list: D000928:Antidepressive Agents