Basic Psychological Needs and Mental Health in Primary Care: A Self-Determination Theory Perspective

Abstract

Highlights Public health relevance—How does this work relate to a public health issue? Mental health concerns are increasingly managed in primary care, yet healthcare systems often remain reactive, fragmented, and focused on symptom management. This study examines how satisfaction and frustration of basic psychological needs relate to resilience, vitality, coping, anxiety, and depression among adult primary care patients. Public health significance—Why is this work of significance to public health? Findings support Self-Determination Theory by demonstrating that psychological need satisfaction is most strongly associated with well-being, whereas need frustration is most strongly associated with psychological distress in primary care. The results identify autonomy, competence, and relatedness as potentially scalable psychological resources that may strengthen prevention, coping, and mental health promotion. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Incorporating psychological need-based perspectives into primary care may complement symptom-focused approaches and promote more holistic mental health care. Future research should examine how healthcare environments and clinical interactions support—or undermine—patients’ experiences of autonomy, competence, and relatedness. Abstract Mental health concerns are increasingly encountered in primary care, yet clinical approaches often focus on symptom management rather than underlying psychological processes. Self-Determination Theory (SDT) proposes that psychological well-being depends on the satisfaction of three basic psychological needs—autonomy, competence, and relatedness—while their chronic frustration contributes to psychological distress. Despite extensive evidence linking these needs to mental health outcomes, their relevance in primary care remains underexplored. This single-center cross-sectional study examined associations between psychological need satisfaction and frustration and indicators of well-being and ill-being among adult primary care patients. A total of 380 patients (Mage = 47.81, SDage = 15.42) completed validated measures of need satisfaction and frustration, resilience, vitality, coping strategies, anxiety, and depression. A dual-process model was examined, with hypotheses informed by SDT: higher need satisfaction associated with greater resilience, vitality, and adaptive coping (well-being), and higher need frustration associated with greater anxiety, depression, and maladaptive coping (ill-being). Although results revealed several significant cross-paths, need satisfaction was most strongly associated with positive outcomes and need frustration was most strongly associated with negative outcomes. The dual-process model did appear clear for coping outcomes, with need satisfaction uniquely predicting adaptive coping and need frustration uniquely predicting maladaptive coping. Findings highlight the potential value of incorporating psychological need-based perspectives into primary care mental health approaches. By recognizing autonomy, competence, and relatedness as foundational psychological resources, healthcare systems may develop more scalable strategies to promote mental well-being and prevent psychological distress in everyday clinical practice.