Motivational interviewing may not increase youths’ mental health care use

Motivational interviewing during specialized pediatric consultations did not increase mental health care service use among adolescents and young adults with chronic medical conditions, according to a cluster randomized clinical trial.

However, it did correlate with longer conversations between patients and physicians and lower anxiety scores at 1 year.

“Identification of psychological disorders and referral to adequate treatment options are important factors for therapy uptake,” Christina Reinauer, MD, of the University Children’s Hospital Düsseldorf in Germany, and colleagues wrote in JAMA Network Open. “Validated tools to detect comorbid mental health problems and brief psychological interventions, such as motivational interviewing (MI), are applicable.

“MI is an evidence-based, collaborative counseling technique, exploring intrinsic motivation and ambivalence,” they added.

Results of prior studies showed MI increased therapy uptake among suicidal patients, as well as the uptake of cognitive behavioral therapy or online interventions for depression among adolescents. Other studies outlined the possibility of implementing MI into clinical routines for improving young patients’ mental health care services utilization.

In the current study, Reinauer and colleagues aimed to evaluate whether MI training for pediatricians could bolster mental health care use among youths. They randomly assigned in clusters treating pediatricians from a single children’s hospital to a 2-day MI workshop or treatment as usual. Patient recruitment and MI conversations took place between April 2018 and May 2020. The study also included 6-month follow-up and 1-year rescreening.

A total of 164 individuals aged 12 to 20 years with chronic medical conditions and comorbid anxiety and depression symptoms (59% girls/women; mean age, 15.2 years) received advice from an MI-trained or untrained physicians to access psychological counseling services.

The researchers used a logistic mixed model that they adjusted for the cluster structure of the data to analyze uptake of mental health care services within the 6-month follow-up, with this uptake serving as the primary outcome. They defined uptake as making one or more appointments by the 6-month follow-up.

Ninety-four (57%) participants received MI and 70 (43%) treatment as usual. Patients whose physicians received MI training did not exhibit a statistically significant difference in mental health care use at 6 months compared with patients receiving treatment as usual. The subjective burden of disease moderated the effect. The researchers noted lower anxiety symptoms scores at 1-year rescreening among those who received counseling from an MI-trained physician. MI training correlated with longer patient-physician conversations, with conversation length significantly affecting uptake rates across conditions.

“The MI approach may help break down barriers and stigma associated with psychological concerns,” the researchers wrote. “Involving pediatricians as facilitators of mental health treatment in a collaborative care setting is a potentially effective and sustainable approach to fill the current treatment gaps.”

In a related editorial, Marie-Eve Robinson, MD, MSc, of the Children’s Hospital of Eastern Ontario in Canada, emphasized the importance of the length of conversations between patients and physicians.

“Although it appears intuitive that spending more time with patients could improve certain behaviors, the work by Reinauer and colleagues is particularly informative on this point, as it demonstrated that the conversation length between the pediatrician and the youth is associated with increased uptake of mental health services,” Robinson wrote. “This suggests that pediatricians could spend more time counseling their patients, at least the ones with moderate to severe psychiatric disorders, who clearly need referral to adequate psychiatric services.”