Integrating Mental Health Services into Primary Health Care

Background: With the establishment of the Community Mental Health Centers (CMHC) came the incorporation of standardized national protocols for diagnosing and treating depression and anxiety at the primary care level. These protocols guide family doctors in using tools like the PHQ-9 and GAD-7 for screening and treatment decisions.

Problem: There is a need to understand the accuracy of family doctors in diagnosing and managing depression and anxiety, the influence of stigma on clinical practice, and barriers faced by patients, including vulnerable groups such as adolescents and refugees. Addressing stigma and identifying patient barriers will contribute to reducing mental health disparities, supporting early intervention, and fostering more inclusive and effective mental health care in Moldova.

Questions: The study poses the following research questions: (1) What is the accuracy rate of family doctors in diagnosing and treating depression and anxiety? (2) How does stigma among family doctors affect their diagnostic and treatment practices? (3) What barriers do patients, including vulnerable populations, face when seeking care for depression and anxiety?

Design & Methods: Using a mixed-methods approach, the study will include quantitative data collection from 460 patients assessed using PHQ-9, GAD-7, and the Depression Stigma Scale (DSS), and qualitative semi-structured interviews with patients and 46 family doctors across 10 health centers. The quantitative analysis will measure diagnostic accuracy through a comparison of family doctors’ assessments with those of mental health professionals, while the qualitative component will explore perceptions, challenges, and patient experiences.

The findings are expected to inform targeted training, enhance diagnostic practices, and guide policy changes to improve mental health service delivery in PHC.