1. Mental Health Trends in a Family Medicine Clerkship: Identifying Patient Populations to Improve Student Learning Scott Renshaw, MD Matthew Holley, MA, MS Jennifer Burba, BS Ashley Butler, BSN Robert Saywell, Jr., PhD, MPH Terrell Zollinger, DrPH

2. Join the conversation Twitter: #STFM15 Disclosure No relevant financial relationships during the past 12 months No conflicts of interest to disclose IRB approved

3. Join the conversation Twitter: #STFM15 Study Purpose Examine the number of student encounters with patients who have mental health disorders in a Family Medicine Clerkship Measure the prevalence of mental health disorders among patients with specific demographic and geographic characteristics

4. Join the conversation Twitter: #STFM15 Hypotheses Students on family medicine rotation will see: – Mental health diagnoses trends in Indiana that follow national trends – Women with greater likelihood of being diagnosed with specific mental health disorders (anxiety, depressive) – A greater number of patients with mental health disorders, if placed the rotation is in rural or Mental Health Professional Shortage Areas

5. Join the conversation Twitter: #STFM15 Methods Patient encounters by third-year medical students in Family Medicine rotations Collected patient demographics, diagnoses Period: June 2009-2011 Coded mental health diagnoses using ICD-9-CM Analyzed using SPSS v.21

6. Join the conversation Twitter: #STFM15 Results Total patient encounters (n=81,296) Patients with mental health diagnoses encountered (13.2%; n=10,709); may include more than one diagnosis per encounter Increase from previous study in 1997-99 (8.0%) (O’Hara, et al, 2001) 12,513 mental health diagnoses recorded

7. Join the conversation Twitter: #STFM15 Results (continued) n % of Mental Health Diagnoses % of All Diagnoses 311: Depressive Disorders4,74737.95.8 300: Anxiety Disorders3,84530.74.7 314: Hyperkinetic Syndrome of Childhood1,42511.41.8 305: Nondependent Abuse of Drugs8336.71.0 307: Special symptoms and syndromes, not elsewhere classified.7235.80.9 302: Sexual and Gender Identity Disorders3132.50.4 295: Schizophrenic Disorders2652.10.3 Other psychiatric diagnoses3622.90.0 Total psychiatric diagnoses12,513 Mental Health Diagnoses Presentations by Psychiatric Diagnoses

8. Join the conversation Twitter: #STFM15 Results (continued) Mental Health Encounter Presentations by Patient Age Anxiety DisordersDepressive Disorder Hyperkinetic syndrome of childhood n%n%n% Childhood (0-17)1524.01803.980857.5 Early Adult (18-35)125533.4125827.137426.6 Middle Adult (36-59)173146.0215946.620314.5 Geriatric (60+)62216.5104022.4191.4 Total376046371404

9. Join the conversation Twitter: #STFM15 Results (continued) Anxiety DisordersDepressive Disorder Hyperkinetic syndrome of childhood n%n%n% Male117931.3131828.383860.2 Female259068.7334071.755439.8 Total376946581392 Mental Health Encounter Presentations by Patient Gender

10. Join the conversation Twitter: #STFM15 Results (continued) Anxiety DisordersDepressive Disorder Hyperkinetic syndrome of childhood n%n%n% MHPSA114529.2159733.652836.8 Non MHPSA238960.9276458.278154.4 Total3534 4361 1309 Mental Health Encounter Presentations by Mental Health Professional Shortage Area Designation

11. Join the conversation Twitter: #STFM15 Discussion Nationally, 26.2% of the adult population has experienced mental illness (NIMH, 2013). In Indiana, there is a marked decline in mental health providers, specifically psychiatrists. In 2013, only 356 psychiatrists reported practicing in the state (Maxey & Norwood, 2014). Why the increase in mental health encounters in Family Medicine practices?

12. Join the conversation Twitter: #STFM15 Discussion (continued) Most common mental health disorders include: depressive, anxiety and attention deficit The most common mental illnesses diagnosed in US are the same (Reeves, et al, 2011). Nearly one-half of adults aged 36-59, presenting with MH disorders, reported anxiety disorders (46.0%) and/or depressive disorders (46.6%). From the Study

13. Join the conversation Twitter: #STFM15 Discussion (continued) Over two-thirds of females presenting with mental health issues were diagnosed with anxiety disorders (68.7%) and/or depressive disorders (71.7%). Of all mental health diagnoses recorded by students, nearly two-thirds (64.1%) were reported in non- MHPSAs.

14. Join the conversation Twitter: #STFM15 Limitations After analysis, it was determined the MHPSAs do not represent the full spectrum of MH provider shortage. 52 of 92 counties have MHPSA designations 25 add’l counties meet designation criteria. Maxey and Norwood, (2014)

15. Join the conversation Twitter: #STFM15 Conclusion Primary care settings may provide insight into current trends of mental illness in Indiana. These insights may help identify gaps in mental health treatment availability. As well, these understandings may demonstrate a need for more robust screening for mental health disorders in the primary care setting.

16. Join the conversation Twitter: #STFM15 Future Impact on Student Learning Program directors would benefit from having a greater understanding of the mental health encounters in various learning environments. Current learner training opportunities in mental health disorders (FMCases, textbooks, didactic discussions) should be reviewed. Appropriate and authentic learning opportunities must be developed to prepare for the growing number of mental health disorders that graduates are likely to encounter.

17. Join the conversation Twitter: #STFM15 References Maxey, H. L., and Norwood, C. W. (2014). Policy report: Indiana mental health workforce. Indiana University: Health Workforce Studies Program. Retrieved from http://hdl.handle.net/1805/5435 http://hdl.handle.net/1805/5435 NIMH, (2013). The Numbers Count: Mental Disorders in America. National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental- disorders-in-america/index.shtml#KesslerLifetime http://www.nimh.nih.gov/health/publications/the-numbers-count-mental- disorders-in-america/index.shtml#KesslerLifetime O’Hara, B.S., Saywell, R.M., Smidley, J.A., Burba, J.L., Thakker, N., Bogdewic, S.P. & Zollinger, T.W. (2001). Medical students’ experience with Psychiatric Diagnoses in a Family Medicine Clerkship. Teaching and Learning in Medicine: An International Journal, 13(3): 167-75. Reeves, W.C., Strine, T.W., Pratt, L.A., Thompson, W., Ahluwalia, I., Dhingra, S.S., Safran, M.A. (2011). Mental Illness Surveillance Among Adults in the United States. Morbidity and Mortality Weekly Report, 60(03): 1-32.