Non-obsessive–compulsive anxiety disorders in child and adolescent mental health services – Are they underdiagnosed, and how accurate is referral information?

Hansen, Berit Hjelde; Oerbeck, Beate; Skirbekk, Benedicte; Kristensen, Hanne Kaae

doi:10.3109/08039488.2015.1061053

Cited by 21 publications

(16 citation statements)

References 27 publications

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“…While the study sample was large, the number of therapists who reported on techniques used for anxiety disorders was relatively small. While this is consistent with the broader literature showing that youth with anxiety disorders present less frequently to treatment in the community relative to disruptive disorders (Merikangas et al, 2011) and that anxiety diagnoses go undetected when youth with anxiety do present (Hansen, Oerbeck, Skirbekk, & Kristensen, 2016), our ability to detect predictors of clinician exposure use was likely underpowered and the marginal effects found should be interpreted with some caution and replicated in additional samples. Clinician use of exposure therapy in this sample also relied on retrospective self-report of techniques used with a representative case, rather than a comprehensive assessment of exposure use across clinician caseloads.…”

Section: Discussionsupporting

confidence: 86%

Predictors of clinician use of exposure therapy in community mental health settings

Becker‐Haimes

Okamura

Wolk

et al. 2017

Journal of Anxiety Disorders

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Exposure therapy is recognized as the key component of cognitive-behavioral treatment for anxiety. However, exposure is the least used evidence-based treatment in community mental health settings and is the most challenging technique for clinicians to adopt within the context of effectiveness and implementation trials. Little work has examined clinician and organizational characteristics that predict use of exposure, which is important for identifying implementation strategies that may increase its use. In a large sample of community health clinicians (N = 335) across 31 clinical practice sites, this study characterized clinician and organizational predictors of exposure use and relaxation for anxiety. Mixed effects regression analyses indicated that both clinician attitudes and an organization’s implementation climate may be important levers for interventions seeking to increase clinician exposure use. Greater clinician use of relaxation strategies was also associated with less exposure use. Results point to important implications for implementing cognitive-behavioral therapy for anxiety, including de-emphasizing relaxation and attending to organizational climate.

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Section: Discussionsupporting

confidence: 86%

Predictors of clinician use of exposure therapy in community mental health settings

Becker‐Haimes

Okamura

Wolk

et al. 2017

Journal of Anxiety Disorders

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“…Overall homotypic comorbidity was in line with the findings reported by Hammerness and colleagues in the United States (13), with most anxiety disorders associated with additional diagnoses of anxiety. Although comorbidity estimates reported by Esbjørn and colleagues in Denmark (12) and by Hansen and colleagues in Norway (14) were markedly lower as compared with the findings of the current study, observations of heterotypic comorbidity as the more prevalent type were similar. Moreover, the percentage point (pp) differences between homotypic and heterotypic comorbidity in those studies (40 pp and 46 pp) were similar to the difference observed in the current study (48 pp), which implies that this comorbidity pattern is a clinical characteristic that can be expected among anxious youths in nonanxiety-specialized psychiatric settings.…”

Section: Discussioncontrasting

confidence: 53%

“…Thus, relating the findings of the current study to three previously reported studies of prevalence in non-specialized psychiatry is curtailed, because the other studies all included either combined samples of children and adolescents or only younger children (12)(13)(14). With this limitation in mind, the prevalence of any anxiety disorder observed in this study is more akin to the estimates of 57.7% reported by Hammerness and colleagues in the United States (13) and 32.7% reported by Hansen and colleagues in Norway (14) rather than to the rate of 5.7% reported by Esbjørn and colleagues in Denmark (12). This must be viewed in relation to the methodological similarities and differences of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, homotypic comorbidity was found in only 2.8% of anxious youths, whereas heterotypic comorbidity (concurrent non-anxiety psychiatric disorder) was observed in 42.9%. With the use of both data collection methods, six non-OCD anxiety disorders were investigated in 407 children between the ages of 7 and 13 years who were referred to child and adolescent psychiatric care in Norway (14). A prevalence of 32.7% of DSM-IV anxiety disorders was found when the K-SADS interview was used as compared with a rate of only 5% when data was collected from a patient register.…”

Section: Classification Of Diseases and Related Health Problems 10thmentioning

confidence: 99%

“…However, there is a paucity of data regarding the prevalence and clinical correlates of multiple anxiety disorders in non-specialized psychiatric outpatient settings, where anxiety may not be a recognized or primary cause for the seeking of help (8,9). Only three prevalence studies of multiple anxiety disorders in non-anxietyspecialized psychiatric settings have been reported, with highly discrepant prevalence rates that make adequate service planning and resource allocation for this setting and patient group difficult tasks (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anxiety Disorders among Adolescents referred to General Psychiatry for Multiple Causes: Clinical Presentation, Prevalence, and Comorbidity

Olofsdotter¹,

Vadlin²,

Sonnby³

et al. 2015

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: Reports of anxiety disorder characteristics among youth in clinical settings typically include descriptions of patients who have been specifically referred for anxiety treatment. At odds with a large body of evidence which demonstrates these disorders to be most common among young people, prevalence studies in samples referred to general psychiatry for multiple causes are scarce and report highly discrepant estimates. Methods: For this study and regardless of their presenting symptoms, 125 adolescents (57.6% girls) between the ages of 12 and 18 years who were consecutively referred to two child and adolescent general psychiatry clinics in Sweden were assessed for anxiety disorders and comorbidity using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Self-ratings of anxiety symptoms and difficulties with family, school, friends, sleep, and body aches were also obtained. Results: At least one anxiety disorder was found in 46% of participants. Among anxious adolescents, homotypic comorbidity (concurrent anxiety) was observed in 43%, and heterotypic comorbidity (concurrent non-anxiety psychiatric disorders) was observed in 91%. No comorbidity was observed in 5%. Trauma, ache, and difficulties making friends were more common among anxious adolescents as compared with psychiatrically referred adolescents without anxiety. Conclusions:The finding that only 21% of adolescents diagnosed with anxiety disorders were referred for anxiety further supports the routine use of standardized and structured instruments-irrespective of referral cause-to improve both precision and detection rates in the clinical setting. Comprehensive assessments are of utmost importance to fully address the complexity of the symptoms in this patient group.

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

Aydın

Crone

Siebelink

et al. 2021

Eur Child Adolesc Psychiatry

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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.

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Non-obsessive–compulsive anxiety disorders in child and adolescent mental health services – Are they underdiagnosed, and how accurate is referral information?

Cited by 21 publications

References 27 publications

Predictors of clinician use of exposure therapy in community mental health settings

Predictors of clinician use of exposure therapy in community mental health settings

Anxiety Disorders among Adolescents referred to General Psychiatry for Multiple Causes: Clinical Presentation, Prevalence, and Comorbidity

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

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