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VBCR - December 2015, Volume 4, No 6 - ACR 2015
Alice Goodman

Rheumatologists are often aware that their patients are experiencing depression, and agree that mental health services are needed to address this. However, many of these physicians feel they lack the skills and time to address mental health issues properly, according to a recent survey.

“Our study points to a gap in care. We found that rheumatologists take mental health issues of their patients seriously and spend time talking about it. Rheumatologists would like patients to access mental health services, but many do not feel confident about having discussions about depression and managing it,” said lead author Erica Heiman, MD, a primary care physician at Kaiser Permanente, University of California Davis Medical Center, Sacramento.

The questionnaire was mailed to 470 practicing rheumatologists in California; the final analysis was based on 226 (55%) responses. The questionnaire asked for information on demographics, practice characteristics, attitudes toward mental health, and strategies related to depression.

Of the responders, 51% reported that at least half of their patients experienced depression, and many of the patients were untreated. Nearly all (99%) rheumatology professionals said they had discussions about depression at “some” time during visits. In most (69%) cases, the rheumatologist initiated the discussions. Only 9% reported use of a formal screening tool for depression.

Rheumatologists were equally likely to prescribe antidepressants, refer patients to a psychiatrist, or refer patients to their primary care physician. Approximately 60% said they used all 3 strategies in at least half of their patients.

Interestingly, less than half (40%) of the respondents said they felt comfortable managing and discussing mental health disorders, and only 24% expressed confidence in doing so.

Among the barriers identified by physicians were lack of resources (27%), services not covered by insurance (47%), and resistance on the part of patients about diagnosis and treatment (66%).

Number of visits to the rheumatologist per week was positively correlated with prescribing antidepressants, whereas number of days in direct patient care was negatively correlated with referral to a primary care physician for further evaluation and treatment of mental health issues.

“This study suggests there is a need for collaborative care for managing mental health issues when caring for patients with RA,” Dr Heiman said.

Reference

Heiman E, Wise B, Kravitz RL. Rheumatologists’ approaches to diagnosis and treatment of depression. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 129.

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