Abstract: Unrecognized Mental Health Needs in Primary Care: Lebanon's Shatila Palestinian Refugee Camp (Society for Social Work and Research 20th Annual Conference - Grand Challenges for Social Work: Setting a Research Agenda for the Future)

Schedule:

Thursday, January 14, 2016: 3:15 PM

Meeting Room Level-Meeting Room 11 (Renaissance Washington, DC Downtown Hotel)

* noted as presenting author

Steven P. Segal, PhD, Mack Distinguished Professor and Director, Mack Center on Mental Health and Social Conflict, University of California, Berkeley, Berkeley, CA

Vicky C. Khoury, MD(Candidate), Medical Student, University of Arizona, Tucson, AZ

Ramy Salah, MD (Candidate), Medical Student, University of California, Los Angeles, Los Angeles, CA

Jess Ghannam, PhD, Clinical Professor, University of California, San Francisco, San Francisco, CA

Background/Purpose: The integration of mental health care and primary care is an objective of first world nations yet in most Middle Eastern countries, given the limited number of specialist providers, it is the default norm. In primary care settings unrecognized mental health need is the extent to which a serious mental disorder extant during a patient contact remains unattended to, undocumented, or absent from consideration. Among primary care outpatients mental disorders are common with 20% to 35% screening positive for any such disorder. Such patients remain inadequately diagnosed and treated despite recognition of the issue and attempts to provide resources for coping with the disorder. This study considers unrecognized mental health need in the primary care services provided within Lebanon’s Shatila Palestinian Refugee Camp and those factors that may contribute to the failure to address such need.

Methods: Data collection (2012-13) involved researcher-administered-structured-surveys of primary healthcare-clinic patients (n=254) using the K6, the PC-PTSD, and the Modified-MINI mental illness screens. Chi. Sq., ANOVA and Principal Component analysis provide descriptive statistics; Logistic regression evaluates risk-factors associated with unrecognized-positive-mental-health-screens.

Results: The sample (n=254) included 55% females and 45% males; aged 18-89, M=40.4(±13). 51.6% screened positive for mental illness, 11.4% (15 of 132) of whom spoke to their physician about mental illness or had an acknowledged record of psychological problems. Thus 88.6% (n=117) had unrecognized-positive-screens. Patient inability to access provider advice or assistance increased chances of having an unrecognized-positive-screen (EXP. B=.0.42; CI: 0.20-0.88) as did patients’ attribution of their mental illness to a physical Illness (EXP. B=5.26; CI: 2.36-11.74), negative attitudes toward the mentally ill (EXP. B=0.92.; CI: 0.86-0.98), female gender (EXP. B=2.20; CI: 1.22-3.95), and lower SES (EXP. B=0.66; CI: 0.48-0.89).

Conclusions: Large numbers of primary care patients screen positive for mental illness whose mental health needs are unrecognized. This seems to result from a perceived lack of access to provider advice—a relationship flaw in service provision. There is a need to address the psychological components of physical health care and self-stigma in the patient-provider contact. A focus on relationship building in primary care settings would significantly enhance the ability of the patient to share their mental health issues and perhaps greatly enhance health outcomes.