Informative value of referral letters from general practice for child and adolescent mental healthcare

Abstract

Although referral letters (RLs) form a nodal point in a patient’s care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9–70.6 for anxiety disorders to 90.5–100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03–1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners’ RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.

Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study

“…People were confused about how, from whom, and where to seek help (Radez et al, 2021 ). We found healthcare professionals, family members, and peers who had previous experience seeking mental healthcare influenced the care-seeking behaviour of people who were unfamiliar with services (Aydin et al, 2021 ). Service use is also influenced by an individual’s ability to have decision-making power and affordability (Hajjaj et al, 2010 ).…”

Addressing the complexity of child psychiatry practice in the current landscape

“…Aydin et al and Hayes et al describe strategies that may improve diagnostic practices and patient engagement in child psychiatry [ 1 , 2 ]. Aydin et al conducted a chart review ( N = 723) of patients treated at specialised mental health care in the Netherlands between 2015 and 2017 and explored the diagnostic informative value of referral letters to child and adolescent psychiatry from general practitioners [ 1 ].…”

“…Aydin et al and Hayes et al describe strategies that may improve diagnostic practices and patient engagement in child psychiatry [ 1 , 2 ]. Aydin et al conducted a chart review ( N = 723) of patients treated at specialised mental health care in the Netherlands between 2015 and 2017 and explored the diagnostic informative value of referral letters to child and adolescent psychiatry from general practitioners [ 1 ]. They found that diagnostic classification was aligned with at least one reason for referral in over half of the cases and had the highest predictive value for predicting eating disorders and the lowest for behavioural problems.…”