Leveraging electronic health records to inform genetic counseling practice surrounding psychiatric disorders

Abstract

Since nearly one‐fifth of US adults have a psychiatric disorder, genetic counselors (GCs) will see many patients with these indications. However, GCs’ reports of inadequate preparation and low confidence in providing care for patients with psychiatric disorders can limit their ability to meet patient's needs. How frequently psychiatric disorders present in GC sessions is currently unclear. Here, we used deidentified electronic health records (EHR) to estimate the prevalence of 16 psychiatric disorders. In 7,155 GC patients, 34% had a diagnostic code associated with a psychiatric disorder; 23% with anxiety/phobic disorders; 21% with mood disorder/depression; 5% with attention deficit hyperactivity disorder (ADHD); and 1% with psychotic disorders. Compared to 415,709 demographically matched controls, GC patients showed a significantly higher prevalence of psychiatric disorders (GC prevalence: 34%, matched prevalence: 30%, p‐value < 0.0001) driven predominantly by anxiety disorder, major depressive disorder, generalized anxiety disorder, and ADHD. Within GC specialties (prenatal: n = 2,674, cancer: n = 1,474, pediatric: n = 465), only pediatric GC patients showed a significant increase in psychiatric disorder prevalence overall (pediatric GC prevalence: 28%, matched prevalence: 13%, p‐value < 0.0001). However, significant evidence of increased prevalence existed for generalized anxiety disorder (prenatal GC prevalence 6.4%, matched prevalence: 4.9%, p‐value < 0.0001), anxiety disorders (cancer GC prevalence: 26%, matched prevalence: 21%, p‐value < 0.0001 and pediatric GC prevalence: 12%, matched prevalence: 5.5%), and ADHD (pediatric GC prevalence: 18%, matched prevalence: 7.9%, p‐value < 0.0001). These results highlight the need for additional guidance around care for patients with psychiatric disorders and the value of EHR‐based research in genetic counseling.

Psychiatric genetic counseling: A survey of Australian genetic counselors' practice and attitudes

“…A second major barrier to PGC identified is that genetic counselors lack confidence in providing PGC. Other studies have suggested barriers to providing PGC may relate to: (1) limited training in PGC, (2) stigma associated with mental illness, (3) balancing existing workload demands, (4) lack of genetic testing, and (5) multifactorial nature of these psychiatric illnesses (Austin et al, 2008; Austin & Honer, 2005; Booke et al, 2020; Inglis et al, 2015; Low et al, 2018; Moldovan et al, 2017; Richter et al, 2022; Rowlatt et al, 2022). These barriers likely contribute to genetic counselors low confidence in the provision of PGC and warrant further investigation in the local setting.…”