BACKGROUND: Primary 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. AIM: To provide a detailed description of the factors associated with both 'correct' and 'excessive' identification of youth mental disorder in primary care. DESIGN OF THE STUDY: Cross-sectional study. SETTING: Twenty-six randomly selected general practices in Victoria, Australia. METHOD: Consecutive young people (16-24 years) were interviewed before their consultation, using a semi-structured 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. RESULTS: Altogether, 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. CONCLUSION: These 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.
BACKGROUND: Primary 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. AIM: To provide a detailed description of the factors associated with both 'correct' and 'excessive' identification of youth mental disorder in primary care. DESIGN OF THE STUDY: Cross-sectional study. SETTING: Twenty-six randomly selected general practices in Victoria, Australia. METHOD: Consecutive young people (16-24 years) were interviewed before their consultation, using a semi-structured 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. RESULTS: Altogether, 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. CONCLUSION: These 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.
Authors: Michael Kaess; Romuald Brunner; Peter Parzer; Vladimir Carli; Alan Apter; Judit A Balazs; Julio Bobes; Horia G Coman; Doina Cosman; Padraig Cotter; Tony Durkee; Luca Farkas; Dana Feldman; Christian Haring; Miriam Iosue; Jean-Pierre Kahn; Helen Keeley; Tina Podlogar; Vita Postuvan; Franz Resch; Pilar A Sáiz; Merike Sisask; Alexandra Tubiana; Peeter Värnik; Marco Sarchiapone; Christina W Hoven; Danuta Wasserman Journal: Eur Child Adolesc Psychiatry Date: 2013-11-19 Impact factor: 4.785
Authors: Ronald C Kessler; Jennifer Greif Green; Michael J Gruber; Nancy A Sampson; Evelyn Bromet; Marius Cuitan; Toshi A Furukawa; Oye Gureje; Hristo Hinkov; Chi-Yi Hu; Carmen Lara; Sing Lee; Zeina Mneimneh; Landon Myer; Mark Oakley-Browne; Jose Posada-Villa; Rajesh Sagar; Maria Carmen Viana; Alan M Zaslavsky Journal: Int J Methods Psychiatr Res Date: 2010-06 Impact factor: 4.035