title: Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder.
abstract: OBJECTIVE
  To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder.
  
  
  METHODS
  A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7.
  
  
  RESULTS
  The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD.
  
  
  CONCLUSIONS
  Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK. Electronic address: Lauren.Rayner@kcl.ac.uk.
authors.forename: L
authors.initials: L
authors.lastname: Rayner
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Matcham
authors.affiliation: South London and Maudsley and King's College Hospital NHS Foundation Trusts, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hutton
authors.affiliation: Information and Communication Technology, King's College Hospital NHS Foundation Trust, UK.
authors.forename: C
authors.initials: C
authors.lastname: Stringer
authors.affiliation: Department of Rheumatology, School of Medicine, King's College London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dobson
authors.affiliation: Department of Rheumatology, School of Medicine, King's College London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Steer
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000592:standards* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006769:Hospitals, General / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D015397:Program Evaluation / Q000592:standards* / Q000706:statistics & numerical data
keywords: Feasibility; General hospital; Integrated care; Mental healthcare; Screening