Determinants of mental health utilization in a palliative care outpatient setting

This study examines the determinants of psychology service utilization among a chronically ill population. Data were combined from an outpatient palliative care clinic using two patient outcome studies for a secondary data analysis. Overall, 149 patients were examined with the majority being middle-aged (M = 55, SD = 14.73), female (n=112; 75.2%) and White (n=123; 82.6%) with a primary diagnosis of cancer (n=117; 78.5%) over a 37 month time period. Using the Behavioral Model of Health Service Use (Andersen, 1995), separate logistic regression analyses were conducted to assess for significant predisposing, enabling and need factor determinants of psychology service utilization in outpatient palliative care. The significant determinants from each of these factors were then modeled together. The total number of visits to see a palliative care physician was found to be the strongest determinant of psychology service utilization (p < .001). Seeing multiple providers was also a statistically significant determinant of psychology service utilization (p = .002) as well as not taking a non-opioid analgesic (p = .024). These findings suggest enabling factors from Andersen's model are most strongly associated with psychology service utilization in outpatient palliative care populations. Of note, many factors associated with need for psychology services, such as emotional distress, psychological symptom burden or having a psychological comorbidity, did not reach significance in determining psychology service use. These findings reinforce previous research that indicates chronically ill individuals are not likely to receive mental health care even though it is documented that they have increased distress related to their mental health. Also, these findings indicate the need for further investigation as to who is receiving referrals for psychology services, as it is noted in the scientific literature that many chronically ill individuals are under-recognized as needing mental health care referrals by their physicians. (Published By University of Alabama Libraries

Brief depression literacy intervention with palliative cancer outpatients

Cancer patients are at risk for depression due to the nature of their disease. Previous investigations indicate patients meeting screening criteria for depression may be underdiagnosed or undertreated for their symptoms. For cancer patients, psychological distress may exacerbate pain, increase desire for hastened death, and increase disability. A randomized controlled trial (RCT) design was employed to determine feasibility and efficacy of a one-time, in-person psychoeducation and depression literacy intervention by comparing it to a treatment as usual (TAU) control group. Outpatient palliative care patients were eligible with PHQ-9 score ≥5, cancer diagnosis, absence of SMI or cognitive impairment, 19 years or older, able to speak and understand English, and available to be reached and communicate by telephone. Baseline and one month follow-up telephone assessments used vignettes and questionnaires to assess depression literacy, psychological distress, and disability. Forty-three patients enrolled, majority white (65%) females (75%) with mean age of 48 years (SD= 11.08). Three intervention participants dropped out before completing the intervention visit and follow-up interview; therefore, 40 participants were included in analysis. Group differences were controlled using propensity score. Intervention participants demonstrated clinically relevant change in depression literacy including: symptom identification (OR=2.0, 95%CI=0.296-13.511), likelihood to seek MH care with counselors (OR=4.059, 95%CI=0.388-42.491), psychiatrists (OR=4.2, 95%CI=0.397-44.4), and social workers (OR=4.2, 95%CI=0.397-44.401), and improved perceptions toward employees (OR=2.556, 95%CI=0.214-30.469) and parents (OR=15.333, 95%CI=1.711-137.404) with severe depression. Decreased somatic complaints (M=-1.7, SE=1.68, d=-0.378) and more stable level of disability were also found (M=-3.0, SE=3.36, d=-0.319). Although results are promising, future studies with more participants, improved outcome measurement, and diversity in the sample are warranted to improve the understanding of the magnitude of change in depression literacy between groups, and improve the generalizability of findings. Integration of the intervention across time, within the clinical setting may increase uptake and completion of the intervention. Also, long term follow-up would allow researchers to track the effect of the intervention on help-seeking behaviors. (Published By University of Alabama Libraries