Acceptability of mental health screening in routine addictions treatment

Delgadillo, Jaime; Gore, Stuart; Jessop, Dawn; Payne, Scott H.; Singleton, Paula; Gilbody, Simon

doi:10.1016/j.genhosppsych.2012.01.006

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…Improvements between assessment and intervention in both depression and alcohol consumption outcomes have also been observed in a recent trial of brief intervention with depressed drinkers [71]. Repeated administration of PHQ-9 has been recommended for clinical practice [72] and been found to be appreciated by patients with mental health or substance use conditions [71,73], and this strategy might be preferable to determine eligibility and outcome in a trial around comorbid mild or moderate depression and excessive drinking. Patten and Schopflocher 72] recommend serial testing strategies for use with the general population, particularly in the immediate range of PHQ-9.…”

Section: Discussionmentioning

confidence: 99%

Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

Wilson

Wray

McGovern

et al. 2014

Trials

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BackgroundMany primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression.MethodsThirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up.ResultsIn the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months.ConclusionsRecruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures.Trial registrationCurrent Controlled Trials ISRCTN89156543; registered 21 October 2013.

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Section: Discussionmentioning

confidence: 99%

Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

Wilson

Wray

McGovern

et al. 2014

Trials

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“…Advantages of brief symptom measures such as PHQ-9 and GAD-7 include their brevity, the option of self-completion and the relatively easy interpretation of scores. Using such measures in routine practice also appears to be acceptable to patients in methadone treatment (Delgadillo et al, 2012b). However, their accuracy is limited by comparison to structured diagnostic interviews.…”

Section: Discussionmentioning

confidence: 99%

Depression and anxiety symptoms: measuring reliable change in alcohol and drug users

Delgadillo

2012

Advances in Dual Diagnosis

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Purpose -This study aims to describe and to compare the reliability and accuracy of different methods of measuring psychiatric symptom changes in the context of substance use. Design/methodology/approach -A group of 60 patients in routine methadone treatment were followed-up during a ''watchful wait'' period of four to six weeks. Diagnoses of common mental disorders meeting International Classification of Diseases (ICD-10) criteria were established using the CIS-R structured diagnostic interview. Brief questionnaires for depression (PHQ-9) and anxiety (GAD-7) were used to measure symptom changes between test and retest. It was hypothesised that the accuracy of symptom changes measured using brief questionnaires may be compromised by methodological artefacts such as poor specificity, regression to the mean and measurement error. These assumptions were tested empirically.Findings -It was demonstrated that measuring change using conventional cut-offs in brief symptom questionnaires tends to overestimate the prevalence of common mental disorders and the rates of improvement. Using higher cut-off scores calibrated in samples of alcohol and drug users, in combination with a reliable change index results in more conservative and reliable estimates of symptom change.Originality/value -This paper presents a considered discussion on the relative merits and limitations of alternative psychiatric symptom measurement methods. These methodological recommendations may be of interest to research and clinical practice concerned with evaluating changes in comorbid depression and anxiety. Important questions are also raised about the modest degree of symptom changes typically observed during a watchful wait period.

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“…Patient Health Questionnaire 9-item scale (PHQ-9). The PHQ-9 is a validated instrument for screening, diagnosing, monitoring, and measuring symptoms of depression (Delgadillo et al, 2012;Kroenke, Spitzer, & Williams, 2001). This self-administered tool rates the frequency and severity of symptoms over the past 2 weeks.…”

Section: Methodsmentioning

confidence: 99%

“…Generalized Anxiety Disorder 7-item scale (GAD-7). The GAD-7 is a self-report anxiety questionnaire designed to assess the patient's anxiety during the past 2 weeks (Delgadillo et al, 2012;Spitzer, Kroenke, Williams, & Löwe, 2006). Participants score seven items on a 4-point Likert scale ranging from 0 (not at all) to 3 (nearly every day).…”

Section: Methodsmentioning

confidence: 99%

Integrating addiction medicine into rural primary care: Strategies and initial outcomes.

Logan¹,

Lavoie²,

Zwick³

et al. 2019

Journal of Consulting and Clinical Psychology

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Objective: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. Method: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N ϭ 101; 45% female, 23% Native Hawaiian or Pacific Islander, M age ϭ 42.5, SD ϭ 12.75). Among patients prescribed buprenorphine (n ϭ 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphinewaivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. Results: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p Ͻ .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. Conclusions: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. What is the public health significance of this article?Addiction medicine services integrated in primary care health care centers can help make treatment for opioid use disorders and comorbid substance use and other mental health conditions accessible for rural underserved populations. The greater improvements associated with remaining in treatment suggest opportunities for multidisciplinary teams to identify and reduce psychological, physical, and psychosocial barriers to remaining in treatment.

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Acceptability of mental health screening in routine addictions treatment

Cited by 8 publications

References 29 publications

Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

Depression and anxiety symptoms: measuring reliable change in alcohol and drug users

Integrating addiction medicine into rural primary care: Strategies and initial outcomes.

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