Are Adolescents Being Screened for Emotional Distress in Primary Care?

Ozer, Elizabeth M.; Zahnd, Elaine; Adams, Sally; Husting, Sheila; Wibbelsman, Charles J.; Norman, Kim P; Smiga, Susan

doi:10.1016/j.jadohealth.2008.12.016

Cited by 58 publications

(47 citation statements)

References 26 publications

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“…15 Where GPs could acknowledge the emotional distress associated with psychological problems they were more flexible, both in their performance in the consultation and interpretation of the problem. Emotional distress is not a diagnostic entity used routinely in clinical practice, and in the literature is often conflated with depression 23,24 yet it can offer a useful framework when considering adolescent difficulties. It reflects the messy reality of consultations where psychological distress may or may not be associated with a diagnosable mental disorder.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Patterns of engagement between GPs and adolescents presenting with psychological difficulties: a qualitative study

Roberts¹,

Crosland

Fulton

2014

Br J Gen Pract

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BackgroundPsychological difficulties are common in adolescence with general practice attendees having higher rates than reported in community surveys. Yet GP identification of common mental health problems in this age group is limited. Anxiety and uncertainty around professional practice have been found among GPs and they vary in their degree of engagement with adolescents presenting with psychological difficulties. AimTo explore which factors influence the degree of GP engagement. Design and settingQualitative study based in 18 practices in the north east of England. The practices recruited included rural, urban, and mixed populations of patients predominantly living in socioeconomically disadvantaged communities. MethodTheoretical sampling was used to guide recruitment of GP participants continuing until theoretical saturation was reached. Data were analysed using the constant comparative method of grounded theory and situational analysis. ResultsIn total 19 GPs were recruited: 10 were female, the age range was 29-59 years, with a modal range of 40-49 years. The participants collectively described a sense of their professional competence being challenged, yet reacted with varying degrees of engagement. Three themes appeared to shape a GP's response: performance in the clinical encounter; view of adolescents and their health needs; and the GP's own preferred epistemological framework. ConclusionThe findings suggest that better patterns of engagement between GPs and adolescents are supported by medical education which includes input and feedback from adolescents; education about the science and psychology of adolescence; more effective working across disciplinary boundaries; and recognition of the importance of addressing psychological difficulties early. Keywordsadolescent psychological difficulties; GP consultation style; youth mental health.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Patterns of engagement between GPs and adolescents presenting with psychological difficulties: a qualitative study

Roberts¹,

Crosland

Fulton

2014

Br J Gen Pract

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“…23 Children with significant depression also are more likely to engage in unhealthy dieting practices and less likely to be able to adopt improved diet and exercise. 24 Although the low overall rate of screening among all adolescents has been found in previous research, 17 this study provides the first look into the lack of attention paid by pediatricians to this issue in overweight or obese teens. Previous studies have concluded that the lower rate of screening among teenagers likely relates to the lack of available referral resources and provider confidence and training in this area.…”

Section: Missed Opportunity For Screening For Emotional Distressmentioning

confidence: 65%

“…On the basis of our previous work on demographic factors that are associated with screening, we adjusted for age, race/ethnicity, income status, and gender in our models. [17][18][19] We repeated this analysis stratified by year to investigate whether the relationship between BMI status and screening by topic differed within each year. We then used 2 testing to determine whether differences in screening by year were statistically significant in an exploratory bivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The higher odds of screening seen in female subjects for emotional distress and Latinos/black subjects for nutrition and physical activity also is consistent with previous findings. 17,18 The change by 2007 is important given that this was the year that the new recommendations were released. 2 Furthermore, overweight adolescents do not experience significantly higher screening during any survey year despite the evidence that they are the group most amenable to early and brief interventions.…”

Section: Discussion Increased Screening For Obese But Not Overweightmentioning

confidence: 99%

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The Association of BMI Status With Adolescent Preventive Screening

2011

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Guidelines ask providers to target adolescent diet and physical activity counseling by BMI status, but providers do not consistently provide this service and often rely on inspection alone versus calculating BMI percentile. WHAT THIS STUDY ADDS:This study investigated whether providers target adolescent preventive screening on the basis of BMI status, with a focus on overweight adolescents, given recent guidelines. The study is strengthened by the use of adolescent self-report versus relying on provider or parent report. abstract OBJECTIVE: To examine the relationship between BMI status (normal, overweight, and obese) and preventive screening among adolescents at their last checkup. METHODS:We used population-based data from the 2003-2007 California Health Interview Surveys, telephone interviews of adolescents aged 12 to 17 years with a checkup in the past 12 months (n ϭ 9220). Respondents were asked whether they received screening for nutrition, physical activity, and emotional distress. BMI was calculated from self-reported height and weight: (1) normal weight or underweight (Ͻ85th percentile); (2) overweight (85th-94th percentile); and (3) obese (Ͼ95th percentile). Multivariate logistic regression models tested how screening by topic differed according to BMI status, adjusting for age, gender, income, race/ethnicity, and survey year. RESULTS:Screening percentages in the pooled sample (all 3 years) were higher for obese, but not overweight, adolescents for physical activity (odds ratio: 1.4; P Ͻ .01) and nutrition (odds ratio: 1.6; screening did not differ P Ͻ .01). Stratified analysis by year revealed higher screening for obese (versus normal-weight) adolescents for nutrition and physical activity in 2003 and for all 3 topics in 2005. However, by 2007, screening did not differ according to BMI status. Overall screening between 2003 and 2007 declined for nutrition (75%-59%; P Ͻ .01), physical activity (74%-60%; P Ͻ .01), and emotional distress (31%-24%; P Ͻ .01). CONCLUSIONS:Obese adolescents receive more preventive screening versus their normal-weight peers. Overweight adolescents do not report more screening, but standards of care dictate increased attention for this group. These results are discouraging amid a rise in pediatric obesity and new guidelines that recommend screening by BMI status.

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“…Yet, only 20%e60% of young people with mental disorder are identified in primary care [3,7e9], with higher rates of underdiagnosis and undertreatment of depression compared with adults [10], which contributes to significant unmet need [11]. Psychosocial assessment is a recommendation within policy and clinical practice guidelines that could be important in reducing the treatment gap were it regularly practiced [12].…”

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confidence: 99%