Stepped psychological intervention with common mental disorders in Primary Care

  • Julio César Martín Servicio Murciano de Salud
  • Ascensión Garriga Servicio Murciano de Salud
  • Carmen Egea Servicio Murciano de Salud
  • Gonzalo Diaz Servicio Murciano de Salud
  • María-Josefa Campillo Servicio Murciano de Salud
  • Rosa María Espinosa Servicio Murciano de Salud
Keywords: Clinical Psychology, primary care, psychological intervention, mental disorder

Abstract

A model of psychological intervention for common mental disorders in Primary Care is analized. Two clinical psychologists and four resident psychologists interviewed 566 users to treat mild to moderate anxiety / depression disorders, bereavement or nonorganic insomnia disorders. Standardized assessment leads to a stepped intervention: indication of no treatment, brief group or individual intervention in Primary Care Center (PCC) or referral to Mental Health.

Socio-demographic and clinical variables describe the sample and allow comparison betwen groups. Of the 566 interviewees, the mean age was 37 years, 70% were women, 50% with psychopharmacological treatment and 10% on sick leave. The steps of intervention were: 19% were intervention indication of no treatment, 71% PCC intervention and 10% were referred to Mental Health. Adaptive, emotional and generalized anxiety disorders were predominant, with significant differences between centers depending on the location and clinical psychologist integration mode in PCC.

Integrating the clinical psychologist in PCC improve access to psychological interventions and reduces mild to moderate mental disorders medication. Assessment prevents unnecessary treatment onset and increases the likelihood of appropriate treatment indications, which is cost-effective.

Author Biographies

Julio César Martín, Servicio Murciano de Salud
JEFE DE SERVICIO DE PROGRAMAS ASITENCIALES DE SALUD MENTAL
Ascensión Garriga, Servicio Murciano de Salud
Coordinadora de Psicología Clínica de la Unidad docente multiprofesional de Salud Mental
Carmen Egea, Servicio Murciano de Salud
Psicóloga clinica
Gonzalo Diaz, Servicio Murciano de Salud
Psicóloglo clínico en centro de salud de Cartagena (Casco y Santa Lucía)
Rosa María Espinosa, Servicio Murciano de Salud
Psicóloga clínica

References

Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An Inventory for Measuring Depression. Arch Gen Psychiatry, 4(6), 561–571.

Bobes, J., Badía, X., Luque, A., García, M., González, M. P., & Dal-Ré, R. (1999). [Validation of the Spanish version of the Liebowitz social anxiety scale, social anxiety and distress scale and Sheehan disability inventory for the evaluation of social phobia]. Medicina clínica, 112(14), 530–538.

Bower, P., & Gilbody, S. (2005). Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. The British Journal of Psychiatry: The Journal of Mental Science, 186, 11–17. https://doi.org/10.1192/bjp.186.1.11

Campbell, B., Staley, D., & Matas, M. (1991). Who misses appointments? An empirical analysis. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 36(3), 223–225.

Cape, J., Whittington, C., & Bower, P. (2010). What is the role of consultation-liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis. General Hospital Psychiatry, 32(3), 246–254. https://doi.org/10.1016/j.genhosppsych.2010.02.003

Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Medicine, 8, 38. https://doi.org/10.1186/1741-7015-8-38

Duro, J. C. (2017). Psicología Clínica en Atención Primaria de Salud: ¿Por qué, para qué y cómo?. Infocop, 9(1). Recuperado de http://www.infocop.es/view_article.asp?id=6586.

Fernández, A., Haro, J. M., Codony, M., Vilagut, G., Martínez-Alonso, M., Autonell, J., … Alonso, J. (2006). Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain. Journal of Affective Disorders, 96(1–2), 9–20. https://doi.org/10.1016/j.jad.2006.05.005

Fernández, A., Pinto-Meza, A., Bellón, J. A., Roura-Poch, P., Haro, J. M., Autonell, J., … Serrano-Blanco, A. (2010). Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study. General Hospital Psychiatry, 32(2), 201–209. https://doi.org/10.1016/j.genhosppsych.2009.11.015

Fernández, A., Rubio-Valera, M., Bellón, J. A., Pinto-Meza, A., Luciano, J. V., Mendive, J. M., … DASMAP investigators. (2012). Recognition of anxiety disorders by the general practitioner: results from the DASMAP study. General Hospital Psychiatry, 34(3), 227–233. https://doi.org/10.1016/j.genhosppsych.2012.01.012

Fogarty, C. T., & Brown, J. B. (2002). Screening for abuse in Spanish-speaking women. The Journal of the American Board of Family Practice / American Board of Family Practice, 15(2), 101–111.

García Moratalla, B, & Ortíz Lobo, A. (2002). Ausencias en las primeras consultas de un centro de salud mental: un estudio controlado. Revista de La Asoción Española de Neuropsiquiatría, 83, 27–36.

Garriga, A., Martín, J.C., Balanza , P, Bonilla, E., Cámara, J., Cánovas, S., … Valero, E. (2010). Guía de práctica clínica de actuación en salud mental de mujeres maltratadas por su pareja. Murcia: Servicio Murciano de Salud. Retrieved from http://www.guiasalud.es/GPC/GPC_470_maltratadas_compl.pdf

Gilbody, S., & Bower, P. (2007). Common mental health problems in primary care: policy goals and the evidence base. In Mental Health Policy and Practice Across Europe (Open University Press, pp. 215–234). Maidenhead: Open University Press.

Harkness, E. F., & Bower, P. J. (2009). On-site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers. In The Cochrane Collaboration & P. J. Bower (Eds.), Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd. Retrieved from http://doi.wiley.com/10.1002/14651858.CD000532.pub2

Haro, J. M., Palacín, C., Vilagut, G., Martínez, M., Bernal, M., Luque, I., … Grupo ESEMeD-España. (2006). [Prevalence of mental disorders and associated factors: results from the ESEMeD-Spain study]. Medicina clínica, 126(12), 445–451.

Layard, R., Clark, D., Knapp, M., & Mayraz, G. (2007). Cost-benefit analysis of psychological therapy. National Institute Economic Review, 202(1), 90–98. https://doi.org/10.1177/0027950107086171

Martín, J. C., Garriga, A., & Egea, C. (2015). Psychological Intervention in Primary Care After Earthquakes in Lorca, Spain. The Primary Care Companion for CNS Disorders, 17(1). https://doi.org/10.4088/PCC.14m01691

Martín, J.C., Garriga, A., Egea, C., & Sainz, C. (2012). Psychological

intervention for survivors of the Lorca earthquakes: an experience of integration in primary care. In Psychological intervention for survivors of the Lorca earthquakes: an experience of integration in primary care. (pp. 37–42). Bologna: Medimond.

Martín, JC, Garriga, A., Pujalte, ML, Balanza, P, San Llorente, C, Guijarro, A, … Martínez-Moya, A. (2009). Generalización y efectividad de la aplicación del modelo de control de pánico en centros de salud mental. Una estrategia de benchmarking. Psicología.com, 13(2). Retrieved from http://www.psiquiatria.com/revistas/index.php/psicologiacom/article/viewFile/674/649/

Martín, JC, Valera, J, Albacete, A, Sánchez, A, & Egea, Carmen.

(2013). Características del TEPT y otros trastornos demorados o cronificados tras los seísmos de Lorca. In Avances en psicología clínica: 2013. Libro de capítulos del VI Congreso Internacional y XI Nacional de Psicología Clínica (Asociación Española de Psicología Conductual (AEPC), pp. 455–463). Granada. Retrieved from http://www.ugr.es/~aepc/WEBCLINICA/DOCUMENTOS/librocapitulosXICong.pdf

Ministerio de Sanidad y Consumo. (2007). Estrategia en Salud Mental del Sistema Nacional de Salud. Ministerio de Sanidad y Consumo. Retrieved from http://www.msssi.gob.es/gl/organizacion/sns/planCalidadSNS/pdf/excelencia/salud_mental/ESTRATEGIA_SALUD_MENTAL_SNS_PAG_WEB.pdf

Mitchell, A. J., Rao, S., & Vaze, A. (2011). Can general practitioners identify people with distress and mild depression? A meta-analysis of clinical accuracy. Journal of Affective Disorders, 130(1–2), 26–36. https://doi.org/10.1016/j.jad.2010.07.028

National Collaborating Centre for Mental Health (Grande-Bretagne), & National Institute for Clinical Excellence (Grande-Bretagne). (2005). Post-traumatic stress disorder : the management of PTSD in adults and children in primary and secondary care. London: Published by Gaskell and the British Psychological Society.

National Collaborating Centre for Mental Health (Great Britain), N. I. for H. and C. E. (Great B., British Psychological Society, & Royal College of Psychiatrists. (2011). Common mental health disorders: identification and pathways to care. Liecester; London: British Psychological Society ; Royal College of Psychiatrists.

National Collaborating Centre for Mental Health (Great Britain), National Institute for Health and Care Excellence (Great Britain), British Psychological Society, & Royal College of Psychiatrists. (2013). Social anxiety disorder: recognition, assessment and treatment.

National Collaborating Centre for Mental Health (Great Britain), National Institute for Health and Clinical Excellence (Great Britain), British Psychological Society, & Royal College of Psychiatrists. (2011). Generalised anxiety disorder in adults management in primary, secondary and community care. London: British Psychological Society : Royal College of Psychiatrists. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK83459/

Navarro-Mateu, F., Tormo, M. J., Salmerón, D., Vilagut, G., Navarro, C., Ruíz-Merino, G., … Alonso, J. (2015). Prevalence of Mental Disorders in the South-East of Spain, One of the European Regions Most Affected by the Economic Crisis: The Cross-Sectional PEGASUS-Murcia Project. PLOS ONE, 10(9), e0137293. https://doi.org/10.1371/journal.pone.0137293

Olatunji, B. O., Cisler, J. M., & Tolin, D. F. (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical Psychology Review, 27(5), 572–581. https://doi.org/10.1016/j.cpr.2007.01.015

Organización Panamericana de la Salud. (2003). Clasificación estadística internacional de enfermedades y problemas relacionados con la salud: CIE-10. Washington: Organización Panamericana de la Salud.

Plazaola-Castaño, J., Ruiz-Pérez, I., & Hernández-Torres, E. (2008). [Validation of the short version of the Woman Abuse Screening Tool for use in primary care in Spain]. Gaceta Sanitaria / S.E.S.P.A.S, 22(5), 415–420.

Richards, D. A., & Borglin, G. (2011). Implementation of psychological therapies for anxiety and depression in routine practice: two year prospective cohort study. Journal of Affective Disorders, 133(1–2), 51–60. https://doi.org/10.1016/j.jad.2011.03.024

Seisdedos Cubero, N., & Spielberger, C. D. (1997). STAI : Cuestionario de ansiedad estado-rasgo. Madrid: TEA.

The ESEMeD/MHEDEA 2000 investigators*, Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., … Vollebergh, W. A. M. (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109(s420), 47–54. https://doi.org/10.1111/j.1600-0047.2004.00330.x

Thompson, C., Ostler, K., Peveler, R. C., Baker, N., & Kinmonth, A. L. (2001). Dimensional perspective on the recognition of depressive symptoms in primary care: The Hampshire Depression Project 3. The British Journal of Psychiatry: The Journal of Mental Science, 179, 317–323.

Tylee, A., & Walters, P. (2007). Underrecognition of anxiety and mood disorders in primary care: why does the problem exist and what can be done? The Journal of Clinical Psychiatry, 68 Suppl 2, 27–30.

Vicente Sánchez, María Pilar, Macías Saint-Gerons, Diego, de la Fuente Honrubia, César, González Bermejo, Diana, Montero Corominas, Dolores, & Catalá-López, Ferrán. (2013). Evolución del uso de medicamentos ansiolíticos e hipnóticos en España durante el período 2000-2011. Revista Española de Salud Pública, 87(3), 247–255.

Von Korff, M., & Goldberg, D. (2001). Improving outcomes in depression. BMJ (Clinical Research Ed.), 323(7319), 948–949.

Published
15-12-2017
How to Cite
Martín, J. C., Garriga, A., Egea, C., Diaz, G., Campillo, M.-J., & Espinosa, R. (2017). Stepped psychological intervention with common mental disorders in Primary Care. Anales De Psicología / Annals of Psychology, 34(1), 30-40. https://doi.org/10.6018/analesps.34.1.281491
Section
Clinical and Health Psychology