Factors associated with non-initiation of mental healthcare after detection of poor mental health at a scheduled health check: a cohort study

Abstract

IntroductionPoor mental health is an important public health concern, but mental health problems are often under-recognised. Providing feedback to general practitioners (GPs) on their patients’ mental health status may improve the identification of cases in need of mental healthcare.ObjectivesTo investigate the extent of initiation of mental healthcare after identification of poor mental health and to identify factors associated with non-initiation.DesignProspective cohort study with 1-year follow-up.SettingIn a population-based health preventive programme, Check Your Health, we conducted a combined mental and physical health check in Randers Municipality, Denmark, in 2012–2015 in collaboration with local GPs.ParticipantsParticipants were 350 individuals aged 30–49 years old with screen-detected poor mental health who had not received mental healthcare within the past year. The cohort was derived from 14 167 randomly selected individuals of whom 52% (n=7348) participated. Mental health was assessed by the mental component summary score of the 12-item Short-Form Health Survey.OutcomeThe outcome was initiation of mental healthcare. Mental healthcare included psychometric testing by GP, talk therapy by GP, contact with a psychologist, contact with a psychiatrist and psychotropic medication.ResultsWithin 1 year, 22% (95% CI 18 to 27) of individuals with screen-detected poor mental health initiated mental healthcare. Among individuals who initiated mental healthcare within follow-up, one in six had visited their GP once or less in the preceding year. Male sex (OR: 0.49 (95% CI 0.28 to 0.86)) and less impaired mental health (OR: 0.93 (95% CI 0.89 to 0.98)) were associated with non-initiation of mental healthcare. We found no overall association between socioeconomic factors and initiating mental healthcare.ConclusionSystematic provision of mental health test results to GPs may improve the identification of cases in need of mental healthcare, but does not translate into initiation of mental healthcare. Further research should focus on methods to improve initiation of mental healthcare, especially among men.Trial registration numberNCT02028195.

Factors associated with mental health service use during the pandemic: Initiation and barriers

“…These findings may reflect increased perceived mental health burden in these individuals. Contrary to earlier studies ( Cornwell et al, 2021 ; Geyti et al, 2020 ), we did not find sex differences in initiating MHSU in individuals with MSS of depression and/or anxiety. This may in part be due to the fact that the majority (80%) of participants reporting MSS of depression and/or anxiety were female.…”

“…In the context of important health service disruptions, shifting from in-person to virtual mental health care, and increased demand and limited access to mental health treatment during the pandemic ( Asmundson et al, 2020 ; Canadian Institute for Health Information, 2022b ; Duden et al, 2022 ; Mental Health Research Canada, 2020 ), few population studies have focused on the factors associated with initiating MHSU. A Danish study conducted prior to the pandemic showed that primary care patients having screened positive for depression and initiating mental healthcare within the year were more likely females and to report more severe impairment in mental health, while education, occupation and income differences were not observed ( Geyti et al, 2020 ). A Veterans Health Administration study in the USA showed that individuals initiating psychotherapy or antidepressant treatment within 3 months of a positive screen for depression were more likely to be females, to report anxiety or post-traumatic stress disorder, to be married, and to be younger than 44 years as compared to older age groups ( Cornwell et al, 2021 ).…”

Identifying patients with psychosocial problems in general practice: A scoping review

“…This insight makes it easier for GPs to provide patient-centered counseling and ask questions that provide a holistic picture of the participant ( 65 ). Geyti et al addressed another aspect in their study, noting that the identification of PSPs does not necessarily lead to the initiation of treatment, where they see a need for further research ( 79 ).…”

Preventive health consultations in general practice for vulnerable adults with psychosocial problems

“…The initial questionnaire screening by SF-12 revealed low mental health among 9% of attenders, corresponding to the background population. Of these, 38.5% had no other high-risk factors according to their health check (Geyti et al, 2020). The intended follow-up at the GP for mental health care was seen for only one out of four with poor mental health, especially no follow-up when being disadvantaged socioeconomically (Geyti et al, 2018(Geyti et al, , 2020.…”

“…Of these, 38.5% had no other high-risk factors according to their health check (Geyti et al, 2020). The intended follow-up at the GP for mental health care was seen for only one out of four with poor mental health, especially no follow-up when being disadvantaged socioeconomically (Geyti et al, 2018(Geyti et al, , 2020. Despite the free offer of follow-up on mental problems, the offer was not accepted by a majority of those with low mental health, perhaps because acceptance needs personal intervention (Geyti et al, 2020).…”