Assessment of co-occurring depression and substance use in an ethnically diverse patient sample during behavioral health intake interviews.

BACKGROUND Co-occurring disorders present a challenge for providers who often fail to diagnose them with accuracy. This study explores the assessment process of co-occurring depressive and substance use disorders in community health clinics serving ethnically diverse patients. The goals are to identify how symptoms discussed in intake, as well as patient and provider characteristics, are associated with receiving a diagnosis of co-occurring disorders or not. METHODS Participation in the study consisted of videotaping the intake, conducting a semi-structured interview, and completing demographic and clinical measures. Quantitative analyses were conducted based on information coded from videotapes of intakes with 119 patients who screened positive for symptoms of depressive disorders and substance use. A subset of cases (28) diagnosed with co-occurring disorders were qualitatively analyzed. RESULTS Results suggest that being female and any discussion of "depression" as a general term increased the likelihood of receiving a diagnosis of depression. Discussing symptoms of drug and alcohol use increased the likelihood of receiving a substance use disorder diagnosis, and discussing symptoms of substance use only increased the likelihood of receiving a dual diagnosis. Qualitative analyses indicate that providers report conducting more systematic assessments for substance use than depressive disorders, which is not supported by the quantitative findings. CONCLUSIONS Our results point to discrepancies in the ways providers and patients describe the assessment of dual diagnoses. Factors such as the role of nonverbal information and patient presentation were identified as contributing to complexity of the assessment.