Effects of brief and depression and anxiety management training on a US Army division’s primary care providers

Introduction
There is a nation-wide gap between the prevalence of mental illness and the availability of psychiatrists. This places
reliance on primary care providers (PCPs) to help meet some of these mental health needs. Similarly, the US Army
expects its PCPs to be able to manage common mental illnesses such as anxiety and depression. Therefore, PCPs must
be able to close their psychiatric skills gaps via lifelong learning.
Materials and Methods
Following needs assessment of PCPs in a US Army division, the curriculum was developed. Objectives targeted
pharmacological management of depression and anxiety. Behavioral intervention skills were also taught to treat insomnia.
Didactics and case-based small groups were used. A novel psychotropic decisional tool was developed and provided
to learners to assist and influence their future psychiatric practice. Pre-training, immediate post-training, and 6-month
assessments were done via survey to evaluate confidence and perceived changes in practice. The curriculum was executed
as a quality improvement project using the Plan, Do, Study, Act framework.
Results
Among 35 learners, immediate confidence in selecting optimal psychotropic and perceived knowledge, skill to change
the dose or type of medication, and confidence in prescribing behavioral sleep improved significantly with large effect
sizes. At 6-month follow-up, learners reported that they were more likely to adjust medications for anxiety or depression
and were more likely to start a new medication for anxiety or depression because of the training with moderate effect
sizes. Use and satisfaction with the psychotropic decisional tool are also reported.
Conclusions
Our psychotropic decisional tool illustrates a novel algorithmic approach for operationalizing the management of
depression and anxiety. Similar approaches can improve the skills of a variety of PCPs in the management of psychiatric
disorders. Further studies in the military operational setting are needed to assess the effects of similar educational
interventions on access to behavioral health care, suicidal behaviors, and unit medical readiness.