Research Projects

Cognitive Aspects of Mental Disorder Diagnosis and Treatment in Primary Care

Science Foundation Arizona

(08101514 PI: Vimla L. Patel)

Depression and anxiety disorders are highly prevalent and often profoundly impairing. In low-income communities, primary care physicians (PCPs) are often the only source of care for these disorders, yet PCPs often under-diagnose and ineffectively manage them. Moreover, little is known about PCPs decision-making processes for mental disorders. This is a new and important focus for services research, driven by the overarching goal of finding more effective ways to deliver psychiatric care in PC. Although there has been considerable work on depression and anxiety disorders in PCPs, little of this work has directly examined the nature of PCPs decision making for these disorders. We propose to apply a cognitive framework to understand the nature of PCPs decision-making in diagnosing and treating major depression (MDD) and post-traumatic stress disorder (PTSD), to provide an in-depth characterization of PCPs knowledge of these disorders and reasoning strategies and relate these processes to quality of care to identify factors that promote or hinder accurate decisions. We will focus on cognition in the context of socio-cultural and environmental factors that affect service delivery to Hispanics. We will use simulated patients, and combine qualitative and quantitative data collection and analysis.

The primary aims of this application are (1) to conduct an ethnographic investigation of the socio-cultural, organizational and environmental factors that affect management of MDD and PTSD in an urban outpatient PC practice; (2) to characterize how the process of doctor-patient interaction during the clinical interview affects PCPs diagnostic decisions about MDD and PTSD (compared to decision-making about a chronic medical disorder), focusing on the impact of cognitive (clinical expertise, decisions), socio-cultural, and environmental factors and identifying sources of inaccuracy; and (3) to analyze how PCPs diagnostic and management decisions for MDD and PTSD emerge and develop throughout the complete patient workup, focusing on how PCPs knowledge of MDD and PTSD affects their ability to integrate information from various stages of the workup. This research will provide a foundation for the development of education and training programs and guidelines for PCPs on how to effectively diagnose and manage MDD and PTSD, taking into account socio-cultural differences, in an effort to reduce disparities in the delivery of mental health care.