Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder

TLDR

General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes. The study aims to assess the feasibility and acceptability of routine web‑based screening for common mental disorders in general hospital settings and to describe their prevalence across six specialties. A web‑based questionnaire comprising mental and physical patient‑reported outcome measures was administered to patients while waiting for appointments in six specialties across three London hospitals; feasibility was measured by completion proportion, and acceptability by decline and assistance rates. Screening completion varied widely (40.1–98.2%), with low decline rates (0.6–9.7%) and modest assistance needs (11.7–40.4%); prevalence of probable depression ranged from 6.6% to 60.9% and anxiety from 11.4% to 25.1%, demonstrating that web‑based screening is acceptable and can be effectively embedded in routine practice.

Abstract

To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder.A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7.The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD.Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.