An innovative 5-Step Patient Interview approach for integrating mental healthcare into primary care centre services: a validation study.

Background: Mental health problems are prevalent among patients seeking primary healthcare. However, traditional patient interviews often fail to identify and manage these problems. Therefore, an improved patient interview process is needed to assess and treat mental health problems in primary care settings. Aims: To assess the validity, reliability, sensitivity and specificity of a 5-Step Patient Interview approach for the screening, diagnosis and treatment of mental health problems. Design and setting: This study compared a 5-Step Patient Interview approach (AlKhathami approach) with expert psychiatric interviews based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) questionnaire from 1 January 2020 to 30 April 2020 in family practice or primary healthcare centres. Methods: A total of 760 participants from five Saudi Arabian regions were selected using a multiclustered random sample of every third patient aged ≥18 years, drawn from the clinics' patient list. Results: A total of 732 patients agreed to participate, with a response rate of 96.3%; 396 (54.1%) were women; the mean (Standard Deviation) age was 41.28 (14.30) years (ranging from 18 to 84 years). Mental health problems were suspected in 40% of the participants. The 5-Step Patient Interview approach was shown to be comparable to an expert interview by a psychiatrist. Moreover, it was more accurate than the PHQ-9 and GAD-7 self-administered questionnaires in screening for stress and classifying it as mild, moderate to severe or severe. Additionally, the 5-Step Patient Interview approach improved physician-patient communication by encouraging the exploration of patients' perspectives. Conclusions: The 5-Step Patient Interview approach is a valid, reliable tool that can aid the integration of mental healthcare into primary healthcare and family practice. Future studies should evaluate the implementation outcomes of the 5-Step Patient Interview approach.

Depression and anxiety among hypertensive and diabetic primary health care patients. Could patients' perception of their diseases control be used as a screening tool?

OBJECTIVES: To measure the frequency and identify risk factors of depression and anxiety among diabetic and hypertensive primary health care (PHC) patients. Also to assess whether patients' perception of their chronic diseases control and sleep disturbance could serve as screening tools for depression and anxiety. Methods: This cross-sectional study of 368 PHC patients was conducted in AlKhobar city, Kingdom of Saudi Arabia between April and May 2015. Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used as diagnostic tools for depression and anxiety. Results: Frequencies, cross-tabulations and logistic regression tests were performed. Patient's perception of chronic diseases control was significantly associated with the presence of depression and anxiety, while it was not seen in the tested disease control (glycated hemoglobin less than 7% and blood pressure less than 140/90 mm Hg). Sleep disturbance has a high specificity (98.9%) in screening for depression. Overall prevalence of depression or anxiety was 57.3% and detected cases was 23%. Depression comprise 48.7% (39.8% mild, 7.1% moderate, 1.8% severe). Anxiety comprise 38.4% (25.1% mild, 8.8% moderate, 4.4% severe). Co-existence of both disorders was 29.5%. Sleep disturbance, weight change, and low income had an independent significant effect on depression and anxiety. Conclusion: Having no sleep disturbance can rule out 98.9% of depression and anxiety cases.  Patient's feelings should be considered in chronic diseases health care plans. Depression or anxiety among diabetic and hypertensive patients have a high morbidity, but with low detection rate.