Do we miss depressive disorders and suicidal behaviours in clinical practice?

Abstract

This study involved a detailed standardized initial research assessment which was carried out with 100 young people aged 12-15 years newly referred to a child and adolescent mental health service. The assessment involved the K-SADS interview with the young person and their parent, the Strengths and Difficulties Questionnaire, the Clinical Global Impression Scale, and the Children's Global Assessment Scale. Diagnoses resulting from these 'research assessments' were compared with clinical diagnoses, which were determined by case note analysis and discussion with the key clinician. Results showed that a clinical diagnosis of depressive disorder was made in only one-third of those who received a 'research assessment' diagnosis of depressive disorder, and suicidality was missed in a significant proportion of cases. Those with a diagnosis of depressive disorder had significantly more problems, more comorbidity, more suicidality and greater functional impairment than those without. It is important to keep depression and suicidality in mind when assessing young people with complex mental health difficulties. Unless specific pointers are sought, it is easy to miss these, which may mean that vulnerable young people do not benefit from potentially effective treatments.

Suicide-related events in young people following prescription of SSRIs and other antidepressants: a self-controlled case series analysis

“…39 However, it is quite likely that the most severe forms (attempted suicides and severe suicidal ideation) are most likely to be recorded by clinicians. Also, in using a self-controlled design, we decrease the chance of misclassifying controls.…”

Measurement Issues: Is standardised diagnostic assessment feasible as an adjunct to clinical practice? A systematic review

“…In this study, seven young people were reported by clinicians to have depression, all of whom met diagnostic criteria on the K‐SADS as did 17 others; no young people were reported as depressed only by clinicians. Both suicidal ideation and suicidal acts were much more commonly reported by young people according to the SDA alone (22% and 19%, respectively) compared to both SDA and clinicians (6% and 6%) or clinicians alone (3%, 1%; Fitzpatrick et al., ). It is notable that 87% of the young people presenting to CAMHS in sample reached research diagnostic criteria.…”

“…Fitzpatrick et al. () focused their paper on depressive disorder, but it was unclear whether the CAMHS team under study specialised in depression. All the other work addressed the broad spectrum of mental health problems.…”

“…Agreement between clinicians and the DAWBA was fair to moderate in the four studies that examined chance corrected agreement (Aebi et al.,; Ford et al., ; Foreman et al., ; Krebs et al., ). Agreement between the Schedule for Affective Disorders and Schizophrenia (K‐SADS) and clinician assessment was similarly moderate (Fitzpatrick et al., ). In this study, seven young people were reported by clinicians to have depression, all of whom met diagnostic criteria on the K‐SADS as did 17 others; no young people were reported as depressed only by clinicians.…”

“…First, three papers suggest that SDAs may assist in the detection of emotional disorders (Aebi et al., ; Fitzpatrick et al., ; Ford et al., ) and comorbidity (Aebi et al., ; Fitzpatrick et al., ; Krebs et al., ) that might not otherwise come to clinical attention during routine practice. The literature comparing informant reports suggests that adults are less likely to report internalising problems than young people (Achenbach, McConaughy, & Howell, ), and it may be that the systematic nature of SDAs offers young people greater opportunity to report emotional difficulties.…”