Factors associated with symptom progress monitoring in a psychiatry specialty clinic network, a retrospective cohort study.

INTRODUCTION: Depression and anxiety are common mental health conditions associated with substantial morbidity and mortality. In psychiatric specialty clinics, standardized symptom monitoring improves outcomes and is recommended in practice guidelines, yet many patients remain unmonitored. This study examined factors associated with completion of standardized depression and anxiety symptom monitoring within a psychiatric specialty clinic network after implementing automated electronic health record workflows to support progress monitoring. METHODS: This retrospective cohort study used data from a large academic psychiatry clinic network (October 2023-September 2024). The cohort included adult patients with at least one return visit; data included patient demographics, visit characteristics, and standardized symptom measure completion. Symptom progress monitoring was defined as completion of at least one relevant standardized measure during a return visit. We found associations between care utilization factors and receipt of monitoring using univariable logistic regression, and multivariable models evaluated for joint effects. RESULTS: Among 6700 patients, 83.6% completed depression monitoring and 81.4% completed anxiety monitoring at least once. Older adults, patients with a non-English language preference, and Black or African American patients were less likely to complete monitoring. Patients with more return visits and virtual visit use were more likely to complete both depression and anxiety monitoring. CONCLUSION: This study is novel in identifying specific patient and care utilization factors associated with progress monitoring in a setting where certain implementation barriers have previously been addressed. Findings demonstrate patterns in who remains unmonitored and highlight the need for targeted strategies to support patients less likely to complete monitoring.