Basic Psychological Needs and Mental Health in Primary Care: A Self-Determination Theory Perspective

Mental health concerns are increasingly encountered in primary care, yet clinical approaches often focus on symptom management rather than underlying psychological processes. Self-Determination Theory (SDT) proposes that psychological well-being depends on the satisfaction of three basic psychological needs—autonomy, competence, and relatedness—while their chronic frustration contributes to psychological distress. Despite extensive evidence linking these needs to mental health outcomes, their relevance in primary care remains underexplored. This single-center cross-sectional study examined associations between psychological need satisfaction and frustration and indicators of well-being and ill-being among adult primary care patients. A total of 380 patients (Mage = 47.81, SDage = 15.42) completed validated measures of need satisfaction and frustration, resilience, vitality, coping strategies, anxiety, and depression. A dual-process model was examined, with hypotheses informed by SDT: higher need satisfaction associated with greater resilience, vitality, and adaptive coping (well-being), and higher need frustration associated with greater anxiety, depression, and maladaptive coping (ill-being). Although results revealed several significant cross-paths, need satisfaction was most strongly associated with positive outcomes and need frustration was most strongly associated with negative outcomes. The dual-process model did appear clear for coping outcomes, with need satisfaction uniquely predicting adaptive coping and need frustration uniquely predicting maladaptive coping. Findings highlight the potential value of incorporating psychological need-based perspectives into primary care mental health approaches. By recognizing autonomy, competence, and relatedness as foundational psychological resources, healthcare systems may develop more scalable strategies to promote mental well-being and prevent psychological distress in everyday clinical practice.