Problems Reported By MS Patients and Their Relationship to Engaging Psychological Consultation

Background: Psychological variables that impact the course/presentation of MS and/or medication adherence often go untreated, making screening and connection to care of critical import.  Although much is known about mental health conditions and psychosocial issues that are often sequelae to MS, little may be known about what problems patients identify on screening, and of the concerns they present with, which ones may trigger consult with psychology for ultimately connecting people to care.

Objectives: The ojective of this study is to explore the problem areas affecting current functioning endorsed by patients that result in help-seeking behavior versus those that do not.  

Methods: Clinical data was collected over a one-period from patients attending medical appointments and receiving medical psychology services in a southeastern Multiple Sclerosis Center.  This center has a patient population of 900 and demographics for this sample of 259 patient contacts are as follows: 55% Caucasian, 44% African American, 79% female, and with an average age of 47 years.

The standard of care for the medical psychology service at this center is to routinely screen patients attending medical visits on an author-derived 18-item Psychological Consultation Problem Checklist (PCPC). The PCPC was developed as a tool to facilitate patient-driven psychological consultations; patients are provided the opportunity to select items which may currently cause distress and may subsequently impact quality of care.  Patients are further screened on three validated screening measures: the Patient Health Questionnaire (PHQ-2; Kroenke, Spitzer, & Williams, 2003) a two-item screener for depression (published α = .83), the Two-Item Conjoint Screener (TICS; Brown et al., 2001) for substance abuse concerns (published α = .86), and the 4-item Primary Care PTSD (PC-PTSD; Prins et al., 2003) screener for posttraumatic stress (published α = .61).  These latter three scales were combined to provide a simplistic, 8- point measure of psychiatric symptom load.

Results: Problems endorsed on the problem checklist of depression, sleep concerns, adjustment to diagnosis, family concerns, sexual functioning problems, and relationship concerns were all significantly correlated with engaging in consultation.  Additionally, persons with more depression (PHQ-2) or greater psychiatric symptom load were more likely to engage in consultation.

Conclusions: These findings are important as engagement in consultation is a necessary first step for connecting patients to an appropriate level of care.  These findings highlight problem areas that are more likely to result in help-seeking behavior and which problems may be too easily disregarded.