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Symposia
Primary Care / Integrated Care
Gabriela K. Khazanov, Ph.D.
Research Psychologist
Corporal Michael J Crescenz VA Medical Center
Philadelphia, Pennsylvania, United States
Courtney Benjamin Wolk, PhD
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Emily Lorenc, BA
Research Coordinator
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Molly Candon, PhD
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Matteo Pieri, BA
Research Coordinator
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
David Oslin, MD (he/him/his)
Chief of Behavioral Health
Corporal Michael J. Crescenz VA Medical Center
Philadelphia, Pennsylvania, United States
Matthew Press, MD
Associate Professor
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Eleanor Anderson, MD (she/her/hers)
Associate Professor
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Emilie Famiglio, B.S.
Clinical Research Coordinator
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania, United States
Shari Jager-Hyman, Ph.D. (she/her/hers)
Assistant Professor
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States
The Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk.
We examined data from the Penn Integrated Care program, an adapted CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: 1) characteristics of patients with and without suicidal ideation who initiated CoCM, 2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and 3) the relationship between amount of CoCM services provided and degree of symptom reduction.
From 2018-2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity.
Suicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM’s potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide.