Table of Contents
International Journal of Family Medicine
Volume 2012, Article ID 507464, 7 pages
Research Article

Integration between Primary Care and Mental Health Services in Italy: Determinants of Referral and Stepped Care

1Dipartimento di Medicina e Sanità Pubblica, Alma Mater Studiorum Università di Bologna, Via San Giacomo 12, 40124 Bologna, Italy
2Dipartimento Salute Mentale e Dipendenze Patologiche, Azienda USL di Bologna, Viale Pepoli 5, 40123 Bologna, Italy
3Istituto di Psichiatria, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40123 Bologna, Italy

Received 15 January 2012; Revised 16 March 2012; Accepted 19 March 2012

Academic Editor: Jan De Lepeleire

Copyright © 2012 Paola Rucci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


This study, carried out in the context of a collaborative care program for common mental disorders, is aimed at identifying the predictors of Primary Care Physician (PCP) referral to Community Mental Health Center (CMHC) and patterns of care. Patients with depression or anxiety disorders who had a first contact with CMHCs between January 1, 2007–December 31, 2009 were extracted from Bologna Local Health Authority database. A classification and regression tree procedure was used to determine which combination of demographic and diagnostic variables best distinguished patients referred by PCPs and to identify predictors of patterns of care (consultation, shared care, and treatment at the CMHC) for patients referred by PCPs. Of the 8570 patients, 57.4% were referred by PCPs. Those less likely to be referred by PCPs were living in the urban area, suffered from depressive disorder, and were young. As to the pattern of care, patients living in the urban area were more likely to receive shared care compared with those living in the nonurban area, while the reverse was true for consultation. Predictors of CMHC treatment were depression and young age. Prospective studies are needed to assess length, quantity, and quality of collaborative treatment for common mental disorder delivered at any step of care.