Original Research April 2026
Baseline Characteristics Associated With Referrals From a Primary Care Mental Health Collaborative Care Model to Specialty Mental Health Services
PCC CNS Disord 2026;28(2):10.4088/PCC.25m04149
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Key Takeaways

From the Authors As published in the article
  1. Pharmacologic collaborative care models can be effective treatments for the management of depression and anxiety in primary care settings.
  2. Certain baseline characteristics are associated with higher rates of referral from a CoCM to specialty psychiatric services including higher severity of baseline depression symptoms, sleep issues, alcohol use disorder, and cannabis use disorder.
  3. Individuals with these characteristics may be more appropriate for specialty mental health clinics as their initial level of care; proactive targeted interventions may also be considered to mitigate concerns related to these characteristics.
Extended Takeaways
  1. In this VA antidepressant monitoring collaborative care program, 131 of 757 veterans (17.31%) were referred to specialty psychiatry, meaning most patients remained managed in primary care despite moderate baseline symptom burden.
  2. Among referred patients, referral destinations were usually general psychiatry rather than narrow subspecialty care: 64 (48.85%) went to the general outpatient mental health clinic, compared with 27 (20.61%) to the women’s center psychiatry clinic and 17 (12.98%) to the PTSD clinic.
  3. Referral was driven overwhelmingly by insufficient clinical improvement, with 121 (92.37%) of referred veterans still having at least moderate depression and/or anxiety symptoms at the time of referral.
  4. Baseline anxiety severity differed between referred and nonreferred groups (P =.001) but did not remain significant in the multivariable model, suggesting depressive burden and selected comorbidities were more informative than GAD-7 score alone when triaging escalation risk.
  5. The strongest multivariable association with referral was current or past cannabis use disorder (OR=2.070, 95% CI, 1.116–3.840), exceeding the effect sizes for sleep issues (OR=1.752, 95% CI, 1.150–2.671) and current or past alcohol use disorder (OR =1.702, 95% CI, 1.024–2.829).
  6. The cohort had substantial clinical complexity at intake, including PTSD in 31.44%, alcohol use disorder in 27.74%, suicidal ideations in 15.97%, and sleep disturbance in 87.22%, underscoring that this primary care model was applied to patients with meaningful psychiatric comorbidity rather than only uncomplicated depression or anxiety.
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