Severity of Mental Health Impairment and Trajectories of Improvement in an Integrated Primary Care Clinic Craig J. Bryan The University of Utah Meghan L. Corso U.S. Navy Bureau of Medicine and Surgery, Washington, DC Kent A. Corso NCR Behavioral Health, LLC, Springfield, Virginia, and Walter Reed National Military Medical Center, Bethesda, Maryland Chad E. Morrow Maxwell Air Force Base, Montgomery, Alabama Kathryn E. Kanzler Malcolm Grow Medical Clinic, Andrews Naval Air Facility, Maryland Bobbie Ray-Sannerud Nellis Air Force Base, Las Vegas, Nevada Objective: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments. Method: Data from 495 primary care patients (61.1% female, 60.7% Caucasian, 37.141  12.21 years of age) who completed the Behavioral Health Measure (Kopta & Lowry, 2002) at each primary care appointment were used for the analysis. Three separate models were constructed to identify clinical improvement in terms of number of appointments attended, baseline impairment severity level, and the interaction of these 2 variables. Results: The data showed that 71.5% of patients improved across appointments, 56.8% of which (40.5% of the entire sample) was clinically meaningful and reliable. Number of appointments and baseline severity of impairment significantly accounted for variability in clinical outcome, with trajectories of change varying across appointments as a function of baseline severity. Patients with more severe impairment at baseline improved faster than patients with less severe baseline impairment. Conclusions: Patients treated within an integrated primary care behavioral health service demonstrate significant improvements in clinical status, even those with the most severe levels of distress at baseline. Keywords: primary care, psychotherapy outcome, multilevel models, integrated care, behavioral health consultation Approximately one quarter of the U.S. population will meet criteria for a mental health disorder in a given year, of which only half will seek treatment (Kessler et al., 2001; Kessler et al., 2005; Regier et al., 1993). Of those who do seek treatment for mental health issues, about half will receive care solely from their primary care provider (Kessler et al., 1994; Regier et al., 1993). Although 20% of patients treated in primary care will be referred to a mental health specialist, 30% to 50% will never make their first appoint- ment (Fisher & Ransom, 1997). It is estimated that up to 70% of primary care patients would benefit from psychosocial or behav- ioral services (Fries et al., 1993), but our current mental health services reach only 6% of this population (Barry, 2003). Unfortu- nately, it often takes many years— up to decades—for individuals with psychiatric conditions to initiate contact for mental health treatment (Wang et al., 2005). In the intervening years, these patients continue to visit their primary care provider (PCP). 1 Over the past few decades, primary care medical settings have become 1 Primary care providers (PCPs) is a broad term that captures all clinical service providers who serve as a patient’s principal source for health care services, which can cut across a range of professions—for example, phy- sicians, physicians assistants, nurse practitioners—working in a variety of clinical specialties, typically family medicine, internal medicine, and ob- stetrics/gynecology. This article was published Online First March 19, 2012. Craig J. Bryan, National Center for Veterans Studies, The University of Utah; Meghan L. Corso, U.S. Navy Bureau of Medicine and Surgery, Washington, DC; Kent A. Corso, NCR Behavioral Health, LLC, Spring- field, VA, and Walter Reed National Military Medical Center, Bethesda, MD; Chad E. Morrow, Maxwell Air Force Base, Montgomery, AL; Kathryn E. Kanzler, Malcolm Grow Medical Clinic, Andrews Naval Air Facility, MD; Bobbie Ray-Sannerud, Nellis Air Force Base, Las Vegas, NV. The views presented in this article are those of the authors and do not necessarily represent the official position or policy of the U.S. Govern- ment, the Department of Defense, the Department of the Air Force, the Department of the Navy, or the Department of the Army. We extend our gratitude to John Connors and Yvonnette Smith for their assistance with the current study. Correspondence concerning this article should be addressed to Craig J. Bryan, National Center for Veterans Studies, The University of Utah, 260 S. Central Campus Drive, Room 205, Salt Lake City, UT 84112. E-mail: craig.bryan@psych.utah.edu Journal of Consulting and Clinical Psychology © 2012 American Psychological Association 2012, Vol. 80, No. 3, 396 – 403 0022-006X/12/$12.00 DOI: 10.1037/a0027726 396