title: Baseline screening tools as indicators for symptom outcomes and health services utilization in a collaborative care model for depression in primary care: a practice-based observational study.
abstract: OBJECTIVE
  Within a practice-based collaborative care program for depression, we examined associations between positive baseline screens for comorbid mental and behavioral health problems, depression remission and utilization after 1 year.
  
  
  METHODS
  This observational study of 1507 depressed adults examined baseline screens for hazardous drinking (Alcohol Use Disorders Identification Test score ≥ 8), severe anxiety (Generalized Anxiety Disorder 7-item score ≥ 15) and bipolar disorder [Mood Disorders Questionnaire (MDQ) positive screen]; 6-month depression remission; primary care, psychiatric, emergency department (ED) and inpatient visits 1 year postbaseline; and multiple covariates. Analyses included logistic and zero-inflated negative binomial regression.
  
  
  RESULTS
  At unadjusted baseline, 60.7% had no positive screens beyond depression, 31.5% had one (mostly severe anxiety), 6.6% had two and 1.2% had all three. In multivariate models, positive screens reduced odds of remission versus no positive screens [e.g., one screen odds ratio (OR) = 0.608, p = .000; all three OR = 0.152, p = .018]. Screening positive for severe anxiety predicted more postbaseline visits of all types; severe anxiety plus hazardous drinking predicted greater primary care, ED and inpatient; severe anxiety plus MDQ and the combination of all three positive screens both predicted greater psychiatric visits (all p < .05). Regression-adjusted utilization patterns varied across combinations of positive screens.
  
  
  CONCLUSIONS
  Positive screens predicted lower remission. Severe anxiety and its combinations with other positive screens were common and generally predicted greater utilization. Practices may benefit from assessing collaborative care patients presenting with these screening patterns to determine resource allocation.
authors.affiliation: Division of Health Policy and Management, University of Minnesota, 420 Delaware St. SE, D375 Mayo MMC 729, Minneapolis, MN 55455. Electronic address: nshippee@umn.edu.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Shippee
authors.affiliation: Mayo Medical School, Mayo Clinic.
authors.forename: Brooke H
authors.initials: BH
authors.lastname: Rosen
authors.affiliation: Department of Family Medicine, Mayo Clinic.
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.affiliation: Department of Psychiatry, Clinica Alemana/Universidad del Desarrollo, Santiago, Chile.
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Fuentes
authors.affiliation: Department of Primary Care Internal Medicine, Mayo Clinic.
authors.forename: Ramona S
authors.initials: RS
authors.lastname: DeJesus
authors.affiliation: Department of Family Medicine, Mayo Clinic.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bruce
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Williams
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000453:epidemiology* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011570:Psychiatry; D011795:Surveys and Questionnaires
keywords: Anxiety; Collaborative care; Depression; Mental and behavioral health screening tools; Utilization