Background: The aims of this study were to test a novel integrated, electronic health record (EHR) screening and treatment of depression, anxiety, and pain.
Methods: Consecutive patients were screened December 12, 2023 and January 15, 2025 using the electronic medical record and automatically referred to the treatment team. Treatment approaches included humanistic or psychoanalytic psychotherapy. Patients’ symptoms were assessed every 6-months. Descriptive statistics and general linear modeling was performed to assess changes over time.
Results: Of 1544 patients were screened, 644 reported clinical levels of symptoms and were offered treatment (42%). A total of 21 (12.4%) patients reported “thoughts of death or wanting to harm themselves” using the PHQ-9. Only 1 (<0.05%) patient had active suicidal ideation. A trend was observed over time in which patients reported a decrease in depressive symptoms [Wilks’ Lambda=3.2, p=0.055] from 14.5 (SD=6.7) to 13.8 (SD=8.3) to 11.3 (SD=7.1) and a significant decrease in anxiety [Wilks’ Lambda=15.6, p<0.001] from 14.9 (SD=4.3) to 11.8 (SD=7.6) to 9.7 (SD=7.1) at 6- and 12 months. A trend was observed over time in which patients reported a decrease in pain intensity and interference [Wilks’ Lambda=199.2, p=0.05] from 6.2 (SD=1.1) 2.1 (SD=2.6) to 0 (SD=0) at 6- and 12- months. A total of 56 (9%) initiated treatment. No significant differences were observed on depressive symptoms [Wilks Lambda=1.01, p=0.378] or anxiety [Wilks Lambda=0.697, p<0.505] for those who initiated treatment versus those who did not initiate treatment. Patients with cancer-related or chronic pain were referred to specialized treatment for pain based on reported etiology of the pain.
Conclusions: Regression to the mean was observed suggesting a robust evidence-based intervention is needed to observe between group differences. Future research may explore patient, provider, and system level reasons patients do not initiate treatment despite clinical levels of symptoms.