By Christopher Cheney
The number of primary care visits for a mental health concern increased from 2006 to 2018, according to a new research article.
According to the National Institute of Mental Health, nearly one in five American adults had a mental, emotional, or behavioral condition in 2020. Mental health conditions have been associated with increased healthcare utilization.
The new research article, which was published in Health Affairs, is based on data collected from more than 100,000 primary care visits from 2006 to 2018. Data was drawn from the National Ambulatory Medical Care Survey.
The new research article has several key data points:
- Primary care visits that had a mental health condition as a primary diagnosis increased from 3.4% of visits in 2006-2007 to 6.3% of visits by 2016 and 2018
- Primary care visits that addressed a mental health concern including visits when a mental health concern was not a primary diagnosis increased from 10.7% of visits in 2006-2007 to 15.9% of visits by 2016 and 2018
- Four factors were associated with a greater likelihood that a mental health concern would be addressed during a primary care visit: younger age, payment through Medicare or Medicaid, female sex, and the visit physician being the patient’s usual primary care physician
- Patients identified as Black or other race were less likely to have a mental health concern addressed in a primary care visit than White patients
- Anxiety and stress-related diagnoses were the most common mental health concerns addressed in primary care visits, peaking at 38.0% of visits for a mental health condition in 2014-2015
- The percentage of primary care visits to address depressive symptoms decreased from 32.4% in 2006-2007 to 20.8% in 2016 and 2018
- The percentage of primary care visits to address serious mental illness decreased from 5.4% of visits in 2006-2007 to 3.0% of visits in 2016 and 2018
- Nearly three-quarters of primary care visits to address a mental health concern resulted in treatment with psychotropic medication, counseling and psychotherapy, or referral to another physician
- The most common treatment offered in primary care visits for a mental health concern was a prescription for a psychotropic medication
Interpreting the data
The increase in primary care visits to address a mental health concern during the study period raises questions about the sustainability of U.S. primary care, the research article’s co-authors wrote. “Although the number of graduating medical students entering primary care specialties continues to be insufficient to meet the growing needs of an aging population, primary care physicians have been asked to provide more and more services, both within the context of the visit and during the intervals between visits.”
To avoid strain on U.S. primary care, primary care physicians should have adequate preparation and resources to address mental health concerns, the research article’s co-authors wrote. “In the context of policy and care delivery changes, equipping primary care providers to address mental health needs is crucial. Resources and systems that support primary care and behavioral health integration, including co-located therapy or psychiatry providers, e-consultation services, longer visit lengths, and billing and documentation systems that simplify addressing both mental and physical health needs may help ease the increasing pressure on primary care providers seeking to address their patients’ needs globally.”
Patients who had visits with their usual primary care physician were more likely to receive care for mental health conditions, the co-authors wrote. “Not surprisingly, mental health concerns were significantly more likely to be addressed in a visit with a patient’s usual primary care physician than in a visit with another primary care physician. In addition, a patient’s own primary care physician was more likely to prescribe a medication to a patient with a mental health concern.”
The data indicate there is a healthcare disparity based on race for primary care visits to address a mental health concern, the co-authors wrote. “Black and Hispanic patients in our sample were disproportionately less likely to have a mental health concern addressed in the context of a primary care visit. The differences in our study in the likelihood of Black or Hispanic patients having a mental health concern addressed outweigh the differences in prevalence of any mental illness among Black versus White and Hispanic versus non-Hispanic people reported in recent national estimates from the National Survey on Drug Use and Health.”
The study’s findings can help guide changes in primary care in the United States, the co-authors wrote. “Given the significant prevalence of mental health diagnoses, the impact of comorbid mental health conditions on utilization, and shortages of mental health professionals, these findings have important implications for the future organization and financing of U.S. primary care.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.