Behavioral Health Services Influence Medical Treatment Utilization Among Primary Care Patients with Comorbid Substance U
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Behavioral Health Services Influence Medical Treatment Utilization Among Primary Care Patients with Comorbid Substance Use and Depression Benjamin I. Felleman • Dylan R. Athenour Minhdan T. Ta • David G. Stewart
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Springer Science+Business Media New York 2013
Abstract Although research has shown benefits of integrating psychological care in primary care settings, it is unclear how this form of treatment impacts individuals with comorbid substance use and depression. The findings are also mixed concerning how frequently this comorbid population seeks primary care services. This study examined the associations between substance use, depression, and medical treatment utilization among 224 primary care patients. The aim of the investigation was twofold. First, to determine if depression increases medical treatment utilization among patients with substance use disorders; second, to evaluate if behavioral health treatment reduces medical service utilization. A moderated mediation model with bootstrapping analyses revealed that depression strengthened the relationship between substance use and primary care treatment utilization (both medical and behavioral health). The model also indicated that behavioral health services were associated with fewer primary care visits for individuals with comorbid substance use and depression. Clinical and social implications are discussed. Keywords Behavioral health Substance use Depression Primary-care
Introduction The purpose of the current study was to examine two frequently co-occurring disorders within primary care-substance use and depression. We specifically sought to B. I. Felleman (&) D. R. Athenour M. T. Ta D. G. Stewart Department of Clinical Psychology, Seattle Pacific University, 3307 Third Ave. W., Ste. 107, Seattle, WA 98119, USA e-mail: [email protected]
identify whether these conditions exacerbate unnecessary (i.e. unrelated to a chronic medical condition) medical treatment utilization (MTU), as well as to determine whether integrated behavioral health services (BHS) mediates this relationship. An estimated 8.9 million individuals are classified as having at least one psychiatric diagnosis in conjunction with a substance use disorder (SUD) (SAMHSA, 2009), thus indicating that comorbidity is the rule rather than the exception (Angold, Costello, & Erkanli, 1999). Among the various psychiatric conditions comorbid with SUDs, major depressive disorder is the most common (Grant et al., 2006). In addition to the high prevalence, individuals with comorbid SUD-depression incur more health-care costs compared to individuals with SUDs alone (Druss & Rosenheck, 1999; McGovern, Clark, & Samnaliev, 2007). However, it is relatively unclear whether the high healthcare costs of this comorbid condition are primarily attributed to medical or mental health treatment utilization and whether these costs subside with treatment. This limitation is in part due to a disconnect between medical and mental health treatment settings. A number of integrated models of healthcare have
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