Primärvården står i dagsläget inför utmaningar gällande omhändertagandet av psykisk ohälsa. Integrerad beteendehälsa (IBH) är en organisatorisk modell med potential att underlätta för hur evidensbaserad psykologisk behandling kan bedrivas i en primärvårdskontext. Syftet med föreliggande studie var att utvärdera en sedvanlig IBH-vårdmodell, kontextuell bedömning följt av fokuserade insatser, med en utökad bedömningsprocedur följt av valet att inleda fokuserade insatser eller vägledd självhjälp, samt de två behandlingsuppläggen fokuserade insatser (oavsett bedömningsförfarande) och vägledd självhjälp efter utökad bedömning. Effekter på vardaglig funktionsnivå, betydelsen av antal behandlingskontakter samt den kontinuerliga upplevelsen av problemets svårighetsgrad, tilltro till den egna förmågan att förändras och besökens hjälpsamhet undersöktes. 69 primärvårdspatienter randomiserades mellan de två vårdmodellerna. Resultaten indikerade på en signifikant förbättring i vardaglig funktionsnivå för samtliga patienter oavsett vårdmodell och behandlingsupplägg. Inget samband mellan antal sessioner och förbättring upptäcktes. Skillnader i utfall och patienternas kontinuerliga upplevelser av behandlingsinterventionerna diskuteras. / The primary healthcare system faces challenges concerning the treatment of mental health. Integrated behavioral health (IBH) is an organizational model with the potential to implement evidence-based psychological treatment in a primary care setting. The aim of this study was to compare a standard IBH treatment model, contextual assessment followed by brief interventions, with an extended assessment procedure followed by brief interventions or guided self-help, as well as the two different treatment plans brief interventions (regardless of assessment procedure) and guided self-help post an extended assessment procedure. Effects on everyday functioning and correlations between number of sessions and treatment effect are evaluated along with the continuous patient experience regarding the severity of the problem, confidence in ability to change and session helpfulness. 69 primary care patients were randomized between the two treatment models. The results indicated a significant improvement in everyday functioning regardless of treatment model or treatment plan. No significant correlation between number of sessions and improvement was found. Differences in treatment outcome and patient experience are discussed.

Mood disorders are often linked with concurrent partner relational distress. The present study compared the cost effectiveness of treating mood disorder alone versus when the condition is comorbid with partner relational distress. Cigna, a leading health insurance management company in the US, provided outpatient data. Participants included patients with solely a mood disorder diagnosis (n = 72,712) and those with both a mood disorder and a comorbid partner relational distress diagnosis (n = 113, including 69 females and 44 males). These participants were treated in outpatient settings throughout the US. These numbers are surprisingly low considering the extensive literature showing a strong relationship between mood disorder and partner relational distress. A multivariate general linear model and binary logistic regressions were used to analyze the data. Results indicate that having a mood disorder present with a partner relational distress disorder significantly increased the average cost of care by about $471 per person compared to having solely a mood disorder. For mood disorders alone, there were also differences in cost effectiveness and readmission for mood disorders by professional license type, age, and gender with counselors being the most cost effective and medical doctors being the least (60% more costly). The treatment modality used impacted readmission rates, with family therapy having the lowest (8.54%) and mixed therapy having the highest (33.54%). Due to the small sample size, we were unable to determine the significance of subsequent analyses for comorbid disorders. Clinical implications and future directions for research will be discussed.

Generalized anxiety disorder (GAD) is frequently found in primary care settings and is highly prevalent among adolescents. The purpose of this study was to examine the cost effectiveness by provider type and therapy modality in treating adolescents (ages 13-17) with a GAD diagnosis (DSM-IV 300.02). A national insurance company in the United States provided outpatient and unidentifiable data for adolescent GAD cases (n = 2,932). These cases were used to analyze the cost effectiveness, total cost, treatment length, dropout, and readmission rates for the treatment of adolescents with GAD. Descriptive statistics signify that the mean cost of treatment for GAD in the first episode of care across all provider types is $439.28. Results revealed significant differences in cost effectiveness, total cost, treatment length, and readmission rates by provider type and therapy modality. MFTs and counselors were most cost effective, had the lowest total cost and number of sessions, as well as the lowest readmission rate among the provider types. In contrast, MSWs and psychologists were the least cost effective, had the highest number of sessions and the highest readmission rate. Therapy modality comparisons indicated that family therapy is most cost effective followed by individual, then mixed therapy modalities. Significantly fewer sessions were found when conducting family therapy upon treating adolescents with GAD. There were no significant differences in dropout by provider type, therapy modality or age group. The results of total cost by gender were also insignificant. Professional and clinical implications and future directions for research will be discussed.

As many as one in five children and adolescents may suffer from a mental health disorder, yet there are barriers that often prevent children from receiving optimal treatment. The current study explores the influence of practitioner license type, therapy modality, diagnosis, age, and gender on mental health therapy for children and adolescents. Data was provided by Cigna, a leading health care insurance provider in the United States. Participants include 106,374 boys (53.2%) and 93,753 girls (46.8%) ages 3 to 18 (M = 12.1, SD = 3.9) who were treated in outpatient facilities throughout the United States of America. Results indicate that there are differences in dropout, recidivism, cost, and treatment length by provider license, therapy modality, diagnosis, age, and gender. Specifically, results suggest that marriage and family therapists have the lowest percent recidivism and are among the lowest in terms of dropout and cost effectiveness. The results also suggest that family therapy is more cost effective than individual or mixed therapy and that mixed therapy has a much lower percent dropout than individual or family therapy. Analysis by diagnosis suggests a potential severity scale based on dropout, recidivism, and number of sessions. There are also significant differences in dropout and recidivism by age suggesting that younger children are more likely to dropout of treatment. These results provide valuable information about mental health treatment of children and adolescents. Specifically, utilizing a family based approach may help reduce the total length of treatment while utilizing a mixed mode approach to therapy may help reduce the risk of dropout from treatment. Also, some diagnoses appear to be more difficult to treat, with higher percentages of dropout and requiring more time and money for successful treatment. Limitations and future directions are discussed.