Defining Mental Disorder: Differences in Primary Care Providers’ and Psychiatrists’ Conceptions of Illness

BACKGROUND: Increasingly primary care providers (PCPs) play a role in recognizing and diagnosing mental disorders. However, how PCPs conceptualize mental disorders within their patient population and how this conceptualization differs and aligns with a more psychiatric approach to mental disorder remains largely unknown. OBJECTIVE: To determine 1) how PCPs and psychiatrists describe their patients with suspected mental health conditions; 2) how PCPs and psychiatrists describe easy to treat and diagnose and challenging to treat and diagnose patients; and 3) how PCPs manage referrals to psychiatry. DESIGN: Online qualitative interviews. PARTICIPANTS: 41 PCPs and 41 psychiatrists. Participants were recruited from two health networks with different catchment areas: Cambridge Health Alliance is on the East coast and primarily serves urban and suburban patients. University of Washington is on the West coast and serves urban, suburban and rural patients. APPROACH: The team performed a deductive analysis of the interview notes using a rapid framework analysis approach. KEY RESULTS: PCPs and psychiatrists describe easy to treat and diagnose patients in similar ways. However, PCPs see complex psychiatric conditions like schizophrenia as more challenging. Those who felt more comfortable managing these complex patients had patients with access to psychiatric services or had access to e-consult services. CONCLUSION: Examining the differences between PCPs and psychiatrists' conceptualization of patients with mental health disorders highlights gaps in mental health care, including the need for PCPs and psychiatrists to collaborate. Collaborations like psychiatric e-consult services could help improve mental health care access, especially in rural areas, for more complex patients whose PCPs may need assistance with diagnosis or treatment management.