The identification of young people's emotional distress: a study in primary care

Abstract

BackgroundPrimary care is a key step in young people's pathway to mental health care. Despite the high prevalence of mental disorder in this age group, little is known about the factors that determine the identification of young people's mental disorder in primary care. AimTo provide a detailed description of the factors associated with both 'correct' and 'excessive' identification of youth mental disorder in primary care. Design of the studyCross-sectional study. SettingTwenty-six randomly selected general practices in Victoria, Australia. MethodConsecutive young people (16-24 years) were interviewed before their consultation, using a semistructured interview. They completed Kessler's scale of emotional distress (K10). GPs completed a questionnaire after the consultation. Multinomial logistic regression was used to examine the factors associated with GP identification of mental disorder in those with high and low probability of disorder on the K10. ResultsAltogether, 450/501 (90%) of approached young people participated; 36.1% (95% confidence interval [CI] = 32.3 to 40.2%) had high probability of mental disorder on the K10. Young people's perception that they had a mental illness was highly associated with GP identification (odds ratio [OR] = 62.6, 95% CI = 22.8 to 172.0). Other significantly associated factors were: patient fears (OR = 2.4, 95% CI = 1.1 to 5.1), frequent consultations (OR = 3.0, 95% CI = 1.0 to 8.4), days out of role (OR = 2.7, 95% CI = 1.2 to 5.7), and continuity of care (OR = 3.4, 95% CI = 1.6 to 6.9). The latter two were also associated with 'over-identification' of young people who had low probability of mental disorder. GP characteristics were not associated with identification. ConclusionThese findings provide guidance for GPs in their clinical work and training. They should also inform the further development of mental health literacy programmes in the community. Keywordsadolescent; beliefs; diagnosis; epidemiology; family practice; mental disorders. INTRODUCTIONMental disorders are a major burden on the health of young people.1 Their severe impact is dramatically illustrated by the fact that most young people who complete suicide suffered mental distress.1-3 Despite increasing knowledge, most affected young people do not receive mental health care. 4 In 1980, Goldberg and Huxley proposed a framework for describing the pathways to mental health care, 5 which was subsequently confirmed by international evidence and remains relevant today. 6,7 Identification of emotional distress in primary care stands out as a key step on the pathway towards accessing mental health treatment.Most young people see a primary care physician at least once a year. 8 Young people with mental disorders consult primary care physicians more often than any other health professional, 9 and the prevalence of mental disorders among young people attending primary care is as high as 30-40%. 4,10,11 Often, however, they do not access professional care Medical training has been proposed as one approach to improv...

Training General Practitioners to Detect Probable Mental Disorders in Young People During Health Risk Screening

“…It has been suggested that strategies to influence young people's recognition of mental health issues might be beneficial alongside strategies to lift GPs' discussion of psychosocial issues [3]; our findings support that these two factors combined lift detection sensitivity.…”

“…Training GPs is clearly only part of the answer. Our study adds to other work suggesting that young people's self-recognition enhances detection, along with continuity of care with the provider [3], destigmatizing mental health and help seeking [35], and adjustments in care organization such as through the use of technological assessments [36].…”

“…Although these findings need to be treated cautiously, since testing multiple definitions increases the probability of a significant result by chance, it is conceivable that because intervention GPs discussed a range of health issues more than comparison GPs, they were more likely to detect self-perceived concerns. Prior work shows GPs are better at detecting mental disorders in young people who perceive that they have a mental disorder [3]. However, discrepancies have been identified in the concordance of young people's and GPs' assessment of having a mental disorder [29].…”

“…We justified the young people's self-perception of having a mental disorder as a "case," based on the perspective that self-perceived mental disorders, with or without a high K10 score, should be addressed by clinicians. Moreover, previous work identifies youth beliefs as a key factor driving clinician recognition and management of mental health issues [3]. Three other possible definitions of "probable mental disorder" were also explored to analyze the extent the chosen definition altered detection sensitivity.…”

“…The high prevalence (30%e40%) of emotional distress [3] is of particular concern because of its effects on education, relationships, and quality of life and its association with other healthcompromising behaviors such as smoking and increased risk of suicide [4,5].…”