Behavioral Health Diagnoses in Rural Primary Care

Abstract

This study examines the rate of detection and overall diagnostic accuracy of depression, anxiety, and trauma disorders in the typical adult primary care medical appointment, in addition to potential associations between demographic characteristics (e.g., sex) and rate of detection for these disorders. For most of the United States population, primary care is the sole source of mental health services. However, primary care providers have minimal behavioral health (BH) training, especially regarding trauma disorders. The present study utilized a sample of rural primary care patients from the Texas A&M University Family Care Clinic (TAMFCC). All patients were referred to the TAMFCC in-house behavioral health consult (BHC) clinic. Self-report measures and a semi-structured interview were used to diagnose patients. We compared the BH diagnosis given by the patient’s primary care physician to the diagnoses given by the BHC team. Primary care physician’s rate of detection for trauma disorders was significantly lower than their rates of detection for both anxiety and depressive disorders. Further, the rate of detection for trauma disorders in female patients was lower than the rate of detection for male patients. Addition of self-report screeners improved the rate of detection for trauma, anxiety, and depressive disorders. These findings support the need for more extensive behavioral health training in medical education and development of protocols for the detection of trauma disorders in primary care (i.e., universal screening).