Defense Date

2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Counseling Psychology

First Advisor

Jared Keeley

Abstract

Primary care behavioral health (PCBH) is crucial for providing mental health treatment to underserved, minority, and uninsured populations. There is a lack of knowledge about accurate mental health diagnoses at PCBH. Underdetection of mental health symptoms has the potential to worsen racial and socioeconomic disparities. Using an expert review process, I developed an abbreviated diagnostic clinical interview (ADCI) for integrated primary care. Next, patients (N = 82) completed the interview after attending PCBH appointments. According to the interview, 63.4% of participants met criteria for a diagnosis, while 64.7% received a diagnosis from their provider. A large portion of patients met criteria for a somatic symptom disorder (25.8%), likely associated with data collection occurring during the COVID pandemic. Kappa agreement between the ADCI and providers’ diagnosis of mood disorders (i.e., depression, anxiety, or both) was significant but in the fair range. The pattern of disagreement demonstrated that the ADCI was significantly more likely to detect comorbid depression and anxiety than providers. Overall, results suggest that the ADCI might be capturing comorbid psychopathology that is underdetected due to the brief PCBH model. For example, referrals from providers often focus on more behavioral health concerns, and the brevity of services does not always allow for in-depth assessment. The ADCI represents an opportunity to improve mental health service in primary care by offering a quick mechanism for identifying a more complete picture of a patient’s mental health concerns.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

4-29-2021

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