SRPH researcher finds disparity in physician, elderly discussion of mental health issues

December 12, 2007

(COLLEGE STATION, TX) — A researcher at the Texas A&M Health Science Center School of Rural Public Health and her colleagues have uncovered an alarming disparity in the time elderly patients and their primary care physicians spend discussing mental health issues.

Raising serious concerns over the quality of mental health care provided in primary care settings, the findings by Ming Tai-Seale, Ph.D., M.P.H., associate professor in the HSC-SRPH and lead study author, are available online and in the December issue of the Journal of the American Geriatrics Society.

Mental health issues, including depression, are serious and treatable. With competent care by physicians and other mental health professionals, recovery is possible. Lack of effective treatment, though, could result in disability and mortality.

Most patients turn to their primary care physician to discuss mental health issues and problems, meaning the quality of mental health care in primary care is critical to many patients’ lives.

“Our society is aging rapidly, and good geriatric care is critical,” Dr. Tai-Seale said. “This study calls attention to how elderly patients’ mental health is addressed in primary care. It also raises concerns about the urgency for restructuring incentives, physician payment and organization of health care to address the complex needs of geriatric patients.”

In the study, by directly observing 392 interactions between patients and physicians, Dr. Tai-Seale and her colleagues found more than half of patients who could have benefited from mental health treatment (suggested by their low self-reported mental health score) did not even have a discussion on mental health. The median time a physician and a patient spent discussing mental health issues was 36 seconds and 69 seconds, respectively.

“Mental health discussions that were brief were generally of poor quality,” Dr. Tai-Seale said. “Merely having longer time didn’t translate directly to higher quality, however. The content of the discussion and physician’s expression of empathy are important elements of care quality that need to be improved.”

Of significant importance to the preservation of life, the authors quote other mental health research showing people over age 65 comprise 13 percent of the population but account for 20 percent of reported suicides. The authors note 20 percent of older people who committed suicide saw a physician on the day they committed suicide, 41 percent had seen a physician within a week, and 75 percent within a month.

Approximately 75 percent of all elderly suicide victims suffer from some sort of psychiatric disorder at the time of their death, with major depressive disorders representing the most common diagnosis. Forty-two percent of elderly patients with major depression who had attempted suicide received antidepressant treatment before the attempt.

To address the public health crisis in late-life mental health care, a key prevention strategy is improved screening of depressed patients by primary care physicians and better treatment of major depression. Effective communication between the patient and physician and timely interfacing with specialty mental health care could improve these critical mental health care processes, Dr. Tai-Seale said.

Other contributors to the Journal of the American Geriatrics Society study were Christopher Colenda, M.D., M.P.H., Jean and Thomas McMullin Dean of the HSC-College of Medicine; David Rosen, Ph.D., professor of humanities in medicine at the HSC-COM and professor of psychology at Texas A&M University; Thomas McGuire, Ph.D., Harvard Medical School; and Mary Ann Cook, Ph.D., JVC Radiology and Medical Analysis, L.L.C. in St. Louis.

Research was supported by a career development grant to Dr. Tai-Seale from the National Institute of Mental Health and a grant to Dr. Cook from the National Institute of Aging.

The research was presented at the 2006 AcademyHealth Annual Research Meeting, during which it was recognized as one of the most outstanding abstracts.

The Texas A&M Health Science Center provides the state with health education, outreach and research. Its six components located in communities throughout Texas are Baylor College of Dentistry, the College of Medicine, the Graduate School of Biomedical Sciences, the Institute of Biosciences and Technology, the Irma Lerma Rangel College of Pharmacy, and the School of Rural Public Health.

— Rae Lynn Mitchell