Recognition of anxiety, depression, and PTSD in patients with COPD and CHF: Who gets missed?

Objective: This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans. Method: Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and healthrelated quality of life (QOL). Results: Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (>= 1 MH encounter or psychiatric medications). Greater depression (p = 0.047) and adaptive coping (p = 0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p < 0.001), higher internal locus of control (p = 0.037), and poorer physical health-related QOL (p = 0.014) were associated with greater likelihood of MH service use. Discussion: Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL.