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

Abstract

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.

GPs’ responses to adolescents presenting with psychological difficulties: a conceptual model of fixers, future planners, and collaborators

“…The key influences were found to be a GP's performance in the clinical encounter; a GP's view of young people and their perception of health needs; and a GP's preferred epistemological framework. 25 This article explores the interrelationship…”

“…Anxiety and uncertainty about professional practice have been found to dominate consultations in this arena, regardless of age or experience of the GP, 24 but GPs vary in their response to professional anxiety with adolescent mental health problems. 25 This article presents data, building on an earlier analysis, to investigate the factors that influence GP engagement in this clinical arena. The key influences were found to be a GP's performance in the clinical encounter; a GP's view of young people and their perception of health needs; and a GP's preferred epistemological framework.…”

“…7,15 GPs describe anxiety and uncertainty about how best to respond to adolescent psychological difficulties, 24 and differ in their degree of engagement with troubled teenagers. 25 Screening for emotional distress has been advocated as a way to raise awareness of adolescent psychosocial problems but has been found to be most effective when linked to collaborative models of care. 8 Dowrick and Reeve suggest that drawing on the wisdom traditions when faced with emotional distress might lead to a more healing response than the pursuit of a diagnosis and cure.…”

“…24 The second level of analysis defined the axial codes presented in a companion article by the authors, 25 which form the pillars of the conceptual model. The final stage of analysis, presented here, determines the theoretical construct (or selective code), which accounts for all the data and which unifies the underpinning themes to produce an overarching conceptual model.…”

Improving the care of adolescents in general practice

“…new models of mental healthcare across the primary-secondary care interface Other articles in this issue explore the GP factors associated with engagement between GPs and adolescents. 1,9 Findings from these studies show that uncertainty, GPs' views of adolescents and their health needs, and the knowledge frameworks employed by GPs when meeting patients affect the role of GPs in managing adolescents' psychological difficulties. New models of collaborative care and continuing editorials "Childhood-onset major depressive disorder displays longer depressive episodes, higher recurrence, more frequent hospitalisation, and more suicidality compared to adult-onset major depressive disorder.…”