: The goal of this qualitative study is to better understand primary care clinicians' approaches to providing mental health care for socially and economically disadvantaged adult patients with chronic disease who receive their care in community health centers (CHCs). With evidence that mental illness increases symptom burden, functional impairment and medical costs, and impedes self-management efforts in people with chronic disease, recognition and management of mental disorders in these patients constitutes an important component of their care. While a large proportion of mental disorders continue to be unrecognized in the U.S. population, evidence shows that socially and economically disadvantaged patients are at greatest risk for non-recognition and inappropriate treatment. Recognition of mental disorders and associated diagnostic decisions are complicated by sociocultural, economic and environmental factors affecting people from culturally diverse backgrounds and those living in poverty, as well as by the co-existence of physical and psychological signs and symptoms. Providing integrated physical and mental health care is thus especially challenging for CHC primary care clinicians whose patients are not only affected by these factors but who also tend to have poorer physical and mental health than the general population. This study uses observation in CHC settings and multiple interview techniques to accomplish two specific aims focused on CHC clinicians' recognition, interpretation and responses to patient psychosocial issues in the context of chronic disease management.
These aims are to: 1) Describe how CHC clinicians frame the psychosocial concerns of and structure the provision of mental health care to patients with chronic disease; and 2) Identify factors that influence CHC clinicians' beliefs, attitudes and clinical decisions in providing mental health care to these patients. The proposal addresses two important areas for improving health care for patients with chronic illness: 1) identification and management of mental illness; and 2) attention to the unique needs of socially and economically disadvantaged patients with chronic illness.
