The impact of psychological assistance in Italian Primary Care: data collected from 2016 to 2018 in the district of Bologna

Bianca Vivit, Luigi Rocco Chiri, Emanuele Ciotti, Chiara Patierno, Gabriella Gallo, Marco Chiappelli, Angelo Fioritti, Domenico Berardi, Marco Menchetti

Abstract


It is common for a general practitioner to meet patients who suffer from mental disorders such as depression or anxiety in the context of Primary Care (Alexander et al., 2008; Anthony et al., 2010; Consensus ISS, 2022; Regier et al. 1978, 1993; Goldberg & Goodyer, 2005; Ustün & Sartorius, 1995; WHO, 2016). This study reports data about clinical activity during the period 2016-2018 regarding the psychological assistance provided by the project “Lo psicologo nella Casa della Salute” in the Italian city of Bologna (Aru et al., 2019). The “Casa della Salute” (CdS) is a territorial health care outpatient facility that aims to offer services of Primary Care to the general population of a specific district.  Moreover, CdS is a starting point for the collaboration between the Mental Health Department (MHD) and the Primary Care Department (PCD). Previous experiences about psychologist in Primary Care (Liuzzi, 2010; Solano, 2009) highlighted: (1) positive increase of therapeutic outcomes through improvement of appropriate access to psychological care and (2) active role of psychologist in promoting communication between different professionals involved in mental health care. In the 2016-2018 period, different interventions have been organized: (1) orientation towards the network of Health Services, (2) psychological interventions to support the activity of the health personnel of the CdS, (3) low intensity psychological intervention (6-8 session), (4) psychotherapy intervention (15-20 session). Statistical analyses have been conducted on a sample of 613 patients who were referred to the psychologist of the CdS. The results indicates that the “Lo psicologo nella Casa della Salute” proposes an effective model of integrated health care.

Keywords


Psychological assistance; Primary care; Mental health; Integrated care; General practitioners.

Full Text:

PDF

References


Alexander, C., & Fraser, J. (2008). General practitioners' management of patients with mental health conditions: the views of general practitioners working in rural north-western New South Wales. The Australian journal of rural health, 16(6), 363–369. https://doi-org.ezproxy.unibo.it/10.1111/j.1440-1584.2008.01017.x

Alshammari, M. A., & Alshammari, T. K. (2021). COVID-19: A new challenge for mental health and policymaking recommendations. Journal of infection and public health, 14(8), 1065–1068. https://doi-org.ezproxy.unibo.it/10.1016/j.jiph.2021.05.020

American Psychological Association. (2016). Resolution on Psychologists in Integrated Primary Care and Specialty Health Settings. Retrieved June 05, 2020 from: http://www.apa.org/about/policy/integrated-primary-care

Anthony, J. S., Baik, S. Y., Bowers, B. J., Tidjani, B., Jacobson, C. J., & Susman, J. (2010). Conditions that influence a primary care clinician's decision to refer patients for depression care. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 35(3), 113–122. https://doi-org.ezproxy.unibo.it/10.1002/j.2048-7940.2010.tb00286.x

Aru F. L., Chiri L. R., Menchetti M., Gallingani F., Filugelli L., Antonica M. R., Ciotti E., Fioritti A., & Berardi D. (2019). Modelli di integrazione tra psicologia e assistenza sanitaria primaria: verso la concreta costruzione di una assistenza psicologica di base? Giornale italiano di psicologia, 1-2, pp. 179-200. Retrieved June 05, 2020 from: https://www.rivisteweb.it/doi/10.1421/93786

Berardi, D., Ferrannini, L., Menchetti, M., & Vaggi, M. (2014). Primary care psychiatry in Italy. The Journal of nervous and mental disease, 202(6), 460–463. https://doi.org/10.1097/NMD.0000000000000145

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet (London, England), 395(10227), 912–920. https://doi-org.ezproxy.unibo.it/10.1016/S0140-6736(20)30460-8

Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC medicine, 8, 38.

https://doi.org/10.1186/1741-7015-8-38

CNOP. Ruolo della psicologia nei Livelli Essenziali di Assistenza. Roma: Consiglio Nazionale Ordine degli Psicologi; 2018. (Quaderno CNOP n. 1, 2018). Retrieved June 05, 2020 from: https://www.psy.it/wp-content/uploads/2018/11/Quaderno_LEA_CNOP.pdf

Derksen, J. (2009). Primary care psychologists in the Netherlands: 30 years of experience. Professional Psychology: Research and Practice, 40(5), 493–501. https://doi.org/10.1037/a0015743

Dunlop, C., Howe, A., Li, D., & Allen, L. N. (2020). The coronavirus outbreak: the central role of primary care in emergency preparedness and response. BJGP open, 4(1), bjgpopen20X101041. https://doi-org.ezproxy.unibo.it/10.3399/bjgpopen20X101041

Goldberg, D. P. & Goodyer, I. (2005). The Origins and Course of Common Mental Disorders (1st ed.). London: Routledge.

Goldberg, D. P., & Huxley, P. (1992). Common mental disorders: A bio-social model. Tavistock/Routledge. Retrieved June 05, 2020 from: https://psycnet.apa.org/record/1992-97161-000

Gupta, S., Jenkins, R., Spicer, J., Marks, M., Mathers, N., Hertel, L., Calamos Nasir, L., Wright, F., Ruprah-Shah, B., Fisher, B., Morris, D., Stange, K. C., White, R., Giotaki, G., Burch, T., Millington-Sanders, C., Thomas, S., Banarsee, R., & Thomas, P. (2017). How primary care can contribute to good mental health in adults. London journal of primary care, 10(1), 3–7. https://doi.org/10.1080/17571472.2017.1410043

Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., McKyer, E., Ahmed, H. U., & Ma, P. (2020). Epidemiology of mental health problems in COVID-19: a review. F1000Research, 9, 636. https://doi.org/10.12688/f1000research.24457.1

Judd, F., Weissman, M., Davis, J., Hodgins, G., & Piterman, L. (2004). Interpersonal counseling in general practice. Australian family physician, 33(5), 332–337.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593

Klerman, G. L., Budman, S., Berwick, D., Weissman, M. M., Damico-White, J., Demby, A., & Feldstein, M. (1987). Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Medical care, 25(11), 1078–1088. https://doi.org/10.1097/00005650-198711000-00006

Lim, J., Broughan, J., Crowley, D., O'Kelly, B., Fawsitt, R., Burke, M. C., McCombe, G., Lambert, J. S., & Cullen, W. (2021). COVID-19's impact on primary care and related mitigation strategies: A scoping review. The European journal of general practice, 27(1), 166–175. https://doi.org/10.1080/13814788.2021.1946681

Liuzzi, M. (2010). Psicologia di Cure Primarie, concetti, metodi e ricerca clinica. Milano, IT: CIS Editore.

McDaniel, S. H., & deGruy, F. V., 3rd (2014). An introduction to primary care and psychology. The American psychologist, 69(4), 325–331. https://doi-org.ezproxy.unibo.it/10.1037/a0036222

Menchetti, M., & Berardi, D. (2015). Manuale di counselling interpersonale. Bologna, IT: Bononia University Press.

Miller, D. (2020). Coronavirus on the inpatient unit: a new challenge for psychiatry. Clin Psychiatry News. Retrieved March 10, 2022 from: https://www.medscape.com/viewarticle/926834#vp_2

National Institute for Health and Clinical Excellence (2009). Depression: The treatment and management of depression in adults. NICE Clinical Guideline, 90. Retrieved June 05, 2020 from: https://www.nice.org.uk/guidance/cg90

National Institute for Health and Clinical Excellence (2011). Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in adults. Management in primary, secondary and community care. NICE Clinical Guideline, 22. Retrieved June 05, 2020 from: https://www.nice.org.uk/guidance/cg113

Radhakrishnan, M., Hammond, G., Jones, P. B., Watson, A., McMillan-Shields, F., & Lafortune, L. (2013). Cost of improving Access to Psychological Therapies (IAPT) programme: an analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region. Behaviour research and therapy, 51(1), 37–45. https://doi-org.ezproxy.unibo.it/10.1016/j.brat.2012.10.001

Regier, D. A., Goldberg, I. D., & Taube, C. A. (1978). The de facto US mental health services system: a public health perspective. Archives of general psychiatry, 35(6), 685–693. https://doi-org.ezproxy.unibo.it/10.1001/archpsyc.1978.01770300027002

Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of general psychiatry, 50(2), 85–94. https://doi-org.ezproxy.unibo.it/10.1001/archpsyc.1993.01820140007001

Serafini, G., Parmigiani, B., Amerio, A., Aguglia, A., Sher, L., & Amore, M. (2020). The psychological impact of COVID-19 on the mental health in the general population. QJM : monthly journal of the Association of Physicians, 113(8), 531–537. Advance online publication. https://doi.org/10.1093/qjmed/hcaa201

Ustün, T. B, & Sartorius, N. (‎1995)‎. Mental illness in general health care: an international study. John Wiley & Sons Ltd, Chichester. Retrieved March 10, 2022 from: https://apps.who.int/iris/handle/10665/36937

Sighinolfi, C., Nespeca, C., Menchetti, M., Levantesi, P., Belvederi Murri, M., & Berardi, D. (2014). Collaborative care for depression in European countries: a systematic review and meta-analysis. Journal of psychosomatic research, 77(4), 247–263. https://doi.org/10.1016/j.jpsychores.2014.08.006

Solano, L., Pirrotta, E., Ingravalle, V., & Fayella, P. (2009). The family physician and the psychologist in the office together: a response to fragmentation. Mental health in family medicine, 6(2), 91–98.

Thomas, S., Jenkins, R., Burch, T., Calamos Nasir, L., Fisher, B., Giotaki, G., Gnani, S., Hertel, L., Marks, M., Mathers, N., Millington-Sanders, C., Morris, D., Ruprah-Shah, B., Stange, K., Thomas, P., White, R., & Wright, F. (2016). Promoting Mental Health and Preventing Mental Illness in General Practice. London journal of primary care, 8(1), 3–9. https://doi.org/10.1080/17571472.2015.1135659

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International journal of environmental research and public health, 17(5), 1729. https://doi.org/10.3390/ijerph17051729

Working Group “Consensus on psychological therapies for anxiety and depression”
2022, x, 105 p. Consensus ISS 1/2022 (in Italian). Retrieved March 10, 2022 from:

https://www.iss.it/consensus-iss/-/asset_publisher/mU25bGuWG08V/content/consensus-iss-1-2022-consensus-conference-sulle-terapie-psicologiche-per-ansia-e-depressione.-documento-finale.-gruppo-di-lavoro-consensus-sulle-terapie-psicologiche-per-ansia-e-depressione-

World Health Organization and Wonca Working Party on Mental Health (2008). What is primary care mental health? Mental health in family medicine, 5(1), 9–13.

World Health Organization (2013). Mental Health Action Plan 2013-2020. Retrieved May 15, 2020 from: https://www.who.int/publications/i/item/9789241506021

World Health Organization (2016). mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP). Retrieved March 10, 2022 from: https://apps.who.int/iris/bitstream/handle/10665/250239/9789241549790-eng.pdf

World Health Organization (2017). Depression and other common mental disorders: Global Health Estimates. Retrieved May 15, 2020 from: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf

Yao, H., Chen, J. H., & Xu, Y. F. (2020). Patients with mental health disorders in the COVID-19 epidemic. The lancet. Psychiatry, 7(4), e21. https://doi.org/10.1016/S2215-0366(20)30090-0

Zgueb, Y., Bourgou, S., Neffeti, A., Amamou, B., Masmoudi, J., Chebbi, H., Somrani, N., & Bouasker, A. (2020). Psychological crisis intervention response to the COVID 19 pandemic: A Tunisian centralised Protocol. Psychiatry research, 289, 113042. https://doi.org/10.1016/j.psychres.2020.113042

Zhang, A., Franklin, C., Jing, S., Bornheimer, L. A., Hai, A. H., Himle, J. A., Kong, D., & Ji, Q. (2019). The effectiveness of four empirically supported psychotherapies for primary care depression and anxiety: A systematic review and meta-analysis. Journal of affective disorders, 245, 1168–1186. https://doi.org/10.1016/j.jad.2018.12.008




DOI: https://doi.org/10.13129/2282-1619/mjcp-3593

Refbacks

  • There are currently no refbacks.