The Primary Care Consultant Toolkit: Tools for Behavioral Medicine

  • Erica M. JarrettEmail author

Basic Facts About Depression in Primary Care

Depression is one of the most common disorders seen in primary medical care clinics, and more patients are treated for depression by primary care providers than by mental health specialists (Katon, 1987; Regier et al., 1993). Research indicates that the general medical practitioner exclusively delivers half of all the formal mental health care in the United States (Narrow et al., 1993). Primary care providers are the sole contacts for more than 50% of patients with mental illness and have thus been described as the defacto system of treatment for mental health (Callahan et al., 1996). Reliable estimates suggest that symptoms consistent with depression are present in nearly 70% of patients who visit primary care providers. Approximately 35% of patients who are seen in primary care meet criteria for being diagnosed with some form of depression, with 10% of patients suffering from major depression. The prevalence of major depression is 2 to 3...


Primary Care Depressive Symptom Cognitive Behavior Therapy Behavioral Health Primary Care Provider 
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Recommended Readings for Managing Depression in Primary Care

  1. Robinson, P., Wischman C., & Del Vento, A. (1996). Treating Depression in Primary Care: A Manual for Primary Care and Mental Health Provider, Reno, NV: Context PressGoogle Scholar
  2. France, R., & Robson, M. (1998). Cognitive Behavioural Therapy in Primary Care: A Practical Guide. London/Philadelphia: Jesicca Kingsley Publishers.Google Scholar
  3. Callaghan, G. M., & Gregg, J. A., (2006). The role of the behavioral health care specialist in the treatment of depression in primary care setting. In W. T. O’Donahue, M. R. Byrd, N. A. Cummings & D. A. Henderson (Ed.), Behavioral Integrative Care: Treatments That Work in the Primary Care Settings (pp. 15–52). New York. Brunner-RoutledgeGoogle Scholar
  4. Anderson, J. E., Michalak, E. E., & Lam, R. W. (2002). Depression in primary care: Tools for screening, diagnosis, and measuring response to treatment. British Columbia Medical Journal, 44(8), 415–419.Google Scholar
  5. Aroll, B., Khin, N., & Kerse, N. (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal, 327, 1144–1146.CrossRefGoogle Scholar
  6. Baron, D. A. (2003). Case histories for understanding depression in primary care. Journal of the American Osteopathic Association, 8(4), 16–18.Google Scholar
  7. Beck, A. T., Ward, C. H., Mendelson, M. Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression . Archives of General Psychiatry, 4, 561–571.PubMedGoogle Scholar
  8. Beck, J. S., & Bieling, P. J. (2004). Cognitive therapy: Introduction to theory & practice. In M. J. Dewan, B. N. Steenbarger, & R. P. Greenberg (Eds.), The Art and Science of Brief Psychotherapies: A Practitioner’s Guide (pp. 1–14). Washington, DC American Psychiatric Publishing, Inc.Google Scholar
  9. Belar, C. D., & Deardorff, W. (1996). Clinical health psychology in medical settings: A practitioner’s guide book. Washington, DC: American Psychological Association.Google Scholar
  10. Budman, S. H., & Butler, S. F. (1997). The lily family depression project: Primary care prevention in action. In N. A. Cummings, J. L. Cummings, J. N. Johnson & N. J. Baker (Eds.) Behavioral health in primary care : A guide for clinical integration. (pp. 219–238). Madison, CT: Psychosocial Press/International Universities Press, Inc.Google Scholar
  11. Callahan, E. J., Bertakis, K. D., Azari, R., Robbins, J., Helms, L. J., & Miller, J. (1996). The influence of depression on physician patient interaction in primary care. Family Medicine, 28, 346–351.PubMedGoogle Scholar
  12. Callaghan, G. M., & Gregg, J. A. (2006). The role of the behavioral health care specialist in the treatment of depression in primary care setting. In W. T. O’Donahue, M. R. Byrd, N. A. Cummings & D. A. Henderson (Eds.), Behavioral integrative care: Treatments that work in the primary care settings (pp. 15–52). New York: Brunner-RoutledgeGoogle Scholar
  13. Clabby, J. F. (2006). Helping depressed adolescents: A menu of cognitive behavioral procedures for primary care. Primary Care Companion Journal of Clinical Psychiatry, 8(6), 131–141.CrossRefGoogle Scholar
  14. Cowley, D. S., Katon, W., & Veith, R. C. (2000). Training psychiatry residents as consultants in primary care settings. Academic Psychiatry, 24, 124–132.CrossRefGoogle Scholar
  15. Craven, M. & Bland, R. (2006). Better practices in collaborative mental health care: An analysis of the evidence base. Canadian Journal of Psychiatry, 51 (Suppl 1). Google Scholar
  16. Ellen, S. R., Norman, T. R., & Burrows, G. D. (1998). 3. Assessments of anxiety and depression in primary care. Medical Journal of Australia, 167, 328–333.PubMedGoogle Scholar
  17. Etherage, J. E. (2005). Pediatric behavioral health consultation. In L. C. James & R. A. Folen (Ed.), The primary care consultant: The next frontier for psychologists in hospitals and clinics (pp. 173–190). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  18. France, R. & Robson, M. (1998). Cognitive behavioural therapy in primary care: A practical guide. London/Philadelphia: Jesicca Kingsley Publishers.Google Scholar
  19. Freedland, K. E., Carney, R. M., & Skala, J. A. (2004). Depression and mood disorders. In L. J. Haas (Ed.) Handbook of primary care psychology (pp. 279–298). Oxford University Press.Google Scholar
  20. Gatchel, R. J., & Oordt, M. S. (2002). Clinical health psychology and primary care. Prctical advice and clinical guidance for successful collaboration. Washington DC: APA.Google Scholar
  21. Genisichen, J., Beyer, M., Muth, C., Gerlach, F., Von Korff, M., & Ormel, J. (2006). Case management to improve major depression in primary health care: a systematic review. Psychological Medicine, 36(1), 7–14. Google Scholar
  22. Gilbody, S. (2004). What is the evidence on effectiveness of capacity building in primary health care professionals in the detection, management, and outcome of depression? Copenhagen, WHO Regional Office for Europe.Google Scholar
  23. Gilbody, S. M., & Bower, P. (2005). Common mental health disorders in primary care – access, effectiveness and choice. In Knapp, M. D., M, Mossialos, E., Thornicroft G. (Eds.). Mental health policy and practice across europe. Buckingham: Open University Press.Google Scholar
  24. Goldberg, D. P., & Black well, B. (1970). Psychiatric illness in general practice. A detailed study using a new method of case identification. British Journal of Medicine, 1, 439–443.CrossRefGoogle Scholar
  25. Griever M., Anderson E., & Baumgarten E. (2005), (January 10). Another approach to managing depression. Canada Family Physician, 51(1), 25–29.Google Scholar
  26. Groth, G. & Elkins, G. (1996). Professional psychologists in general health care settings: A review of the financial efficacy of direct treatment interventions. Professional Psychology: Research & Practice, 27, 161–174. Google Scholar
  27. Gunning, K. (2004). Could the symptoms be caused by the Patient’s Medication? A guide to assessment. In L. J. Haas (Ed.) Handbook of primary care psychology (pp. 611–626). Oxford University Press.Google Scholar
  28. Hirschfeld, R. M. (2001). The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Primary Care Companion Journal Clinical Psychiatry, 3(6), 244–252.CrossRefGoogle Scholar
  29. Katon, W. (1987). The epidemiology of medical care. International Journal of Psychiatry in Medicine, 17, 93–112.PubMedCrossRefGoogle Scholar
  30. Katon, W., & Schulberg, H. (1992). Epidemiology of depression in primary care. General Hospital Psychiatry, 14, 237–247.PubMedCrossRefGoogle Scholar
  31. Katon, W., Von Korff, M., & Lin E. (1990). Distressed high utilizers of medical care: DSMIII-R diagnosis and treatment needs. General Hospital Psychiatry, 12, 355–362.PubMedCrossRefGoogle Scholar
  32. Kop, W. J., & Ader D. N. (2001). Assessment and treatment of depression in coronary artery disease patients. Italian Heart Journal, 2, 890–894.PubMedGoogle Scholar
  33. Kupfer, D. J., & Freedman, D. X. (1986). Treatment for depression. Archives of General Psychiatry, 43, 509–511.PubMedGoogle Scholar
  34. Lave, J. R., Frank, R. G., Schulberg, H. C., & Kamlet, M. S. (1998). Cost effectiveness of treatments for major depression in care practice. Archives of General Psychiatry, 55(7), 645–651. Google Scholar
  35. McQuaid, J. R., Stien M. B., Laffaye C., & MCCahill M. E. (1999). Depression in a primary care clinic: The prevalence and impact of an unrecognized disorder. Journal of Affective Disorder, 55, 1–10.CrossRefGoogle Scholar
  36. Munoz, R. F., Hollon, S. D., McGrath, E., Rhem, L. P., & VandenBos, G. R. (1994). On the AHCPR depression in primary care guidelines: Further considerations for practitioners. American Psychologist, 49, 42–61.PubMedCrossRefGoogle Scholar
  37. Narrow, W., Reiger, D., Rae, D., Manderscheid, R., & Locke, B., (1993) . Use of services by persons with mental and addictive disorders: Findings form the national Institute of mental Health Epidemiological Catchment Area Program. Archives of General Psychiatry, 50, 95–107.Google Scholar
  38. Paykel, E. S., & Priest, R. G. (1992). Recognition n& management of depression in general practice: Consensus statement. British Medical Journal, 305, 1198–1202.PubMedCrossRefGoogle Scholar
  39. Perez-Stable, E. J., Miranada, J., Munoz, R. F., & Ying , Y. W. (1990). Depression in medical outpatients. Underrecognition and misdiagnosis. Archives of Internal Medicine, 150, 1083–1088.PubMedCrossRefGoogle Scholar
  40. Pignone, M., Gaynes, B. N., Rushton, J. L., et al. Screening for Depression. Systematic Evidence Review No. 6 (Prepared by the Research Triangle Institute—University of North Carolina Evidence-based Practice Center under Contract No. 290-97-0011) AHRQ Publication. No. 02-S002. Rockville, MD: Agency for Healthcare Research and Quality, May 2002.Google Scholar
  41. Radloff, L. S. (1977). The CES-D scale. A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  42. Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The defacto U.S. mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives General Psychiatry, 50, 85–94.Google Scholar
  43. Robinson, P. J., & Reiter, J. T. (2007). Behavioral Consultation and Primary Care: A guide to Integrating Services. New York: Springer.CrossRefGoogle Scholar
  44. Robinson, P., Wischman, C., & Del Vento, A. (1996). Treating depression in primary care: A manual for primary care and mental health provider, Reno, NV: Context Press.Google Scholar
  45. Rowan, A. B., & Runyan, C. N. (2005). A primer on the consultation model of the primary care behavioral health integration. The Primary Care Consultant: The next frontier for psychologists in hospitals and clinics (pp. 9–28). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  46. Schade, C. P., Jone, E. R. J., & Wittlin, B. J. (1998). A ten year review of the validity and clinical utility of depression screening. Psychiatric Services, 55, 1121–1127.Google Scholar
  47. Simon, G. E., Revicki, D., Heiligenstein, J., Grothaus, J., Vonkorff, M., Katon, W., & Hylan, T. (2000). Recovery from depression, work productivity, and health care cost among primary care patients. General Hospital Psychiatry, 22, 153–162.PubMedCrossRefGoogle Scholar
  48. Sharp, L. K.,& Lipsky, M. S. (2002). Screening for depression across the life span: A review of measures for use in primary care settings. American Family Physician, 66(6), 1–15.Google Scholar
  49. Steenbarger B. (1994). Duration and outcome in psychotherapy: An integrative review. Profession Psychology Research & Practice, 25, 111–119. Google Scholar
  50. Steenbarger, B. N., Greenberg, R. P., & Mantosh, J. D. (2004). Introduction. In M. J. Dewan, B. N. Steenbarger, & R.P Greenberg (Eds.), The art and science of brief psychotherapies: A practitioner’s guide (pp. 1–14). Washington, DC: American Psychiatric Publishing, Inc.Google Scholar
  51. Strosahl, K. D. (2005). Training behavioral health and primary care providers for integrated care: A core competency approach. In W. T. O’Donahue, M. R. Byrd, N. A. Cummings & D. A. Henderson (Eds.), Behavioral Integrative Care: Treatments that work in the primary care settings (pp. 15–52). New York: Brunner-Routledge.Google Scholar
  52. US Air force Medical Operations Agency Population Health support Division, Office for Prevention & Health Services Assessment. 2002. Primary care behavioral health care services practice manual version 2.0. Manual/primary%20care%20practice%20manual.pdf
  53. Von Korff, M., Glasgow, R. E., & Sharpe, M. (2002). ABC of psychological medicine: Organizing care for chronic illness. British Medical Journal, 325, 92–94.CrossRefGoogle Scholar
  54. Yesavage, J. A., Brink, T. L., Rose, T. L. Lum, O., Huang, V. Adey, M. & Leier, V. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49.PubMedCrossRefGoogle Scholar
  55. Zung, W. W. (1965). A self rating depression scale.Archives of General Psychiatry, 12, 63–70.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Chief, Primary Care Psychology Service, Department of Internal MedicineWalter Reed Army Medical CenterWashingtonUSA

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