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

Ambresin, Anne‐Emmanuelle; Otjes, Christiaan P.; Patton, George C.; Sawyer, Susan Μ; Thuraisingam, Sharmala; English, Dallas R.; Haller, Dagmar M.; Sanci, Lena

doi:10.1016/j.jadohealth.2017.03.015

Cited by 5 publications

(2 citation statements)

References 28 publications

(41 reference statements)

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“…96 Similar findings are reported from a joint Australia-Switzerland initiative to investigate whether a training intervention increases GPs' detection sensitivity for probable mental disorders in young people. 97 While improvements in detection were demonstrated these related only to more clearly detected cases and not to a more pragmatic clinical definition. The authors concluded that improving recognition of mental disorder among young people attending primary care is likely to require a multifaceted approach targeting young people and GPs.…”

Section: Supporting Evidencementioning

confidence: 99%

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Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Cantrell,

Sworn,

Chambers

et al. 2024

Health Soc Care Deliv Res

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Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

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Section: Supporting Evidencementioning

confidence: 99%

“…The authors concluded that improving recognition of mental disorder among young people attending primary care is likely to require a multifaceted approach targeting young people and GPs. 97 Training is a necessary, but not sufficient condition for improved detection.…”

Section: Supporting Evidencementioning

confidence: 99%

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Cantrell,

Sworn,

Chambers

et al. 2024

Health Soc Care Deliv Res

View full text Add to dashboard Cite

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Wellbeing and mental health interventions for Indigenous children and youth: A systematic scoping review

Jongen

Campbell

Saunders

et al. 2023

Children and Youth Services Review

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Far from acceptable: youth-reported risk behaviour screening by primary care physicians

et al. 2020

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Abstract Background Adolescence and early adulthood are periods of experimentation during which health detrimental behaviours might be acquired. Objective This study’s purpose is to evaluate physicians’ likelihood of addressing health risk behaviours with youths depending on the youths’ wishes, risk behaviours and personal characteristics. Methods Data were drawn from the third wave (2017–18) of the GenerationFRee longitudinal study carried out on a sample of 1970 youths aged 17–26 in Switzerland. Analysed risk behaviours were: eating disorders, substance use, emotional wellbeing, problematic Internet use and gambling. Bivariate and multivariate analyses were performed, results are presented as adjusted odds ratios (aORs). Results Physicians discussed most risk behaviours with less than half of the youths. The odds of addressing risk behaviours were seldom raised when the risk behaviour was present, or when the youth wished to discuss it. Emotional wellbeing was addressed with half as many males as females (aOR 0.47), and drugs were found to be addressed more frequently with youths reporting a low family socio-economic status (aOR 6.18). When a risk behaviour is addressed it is mostly alongside an extended screening. Conclusions This study confirmed the low levels of health risk behaviours screening, regardless of the youths’ wish to discuss the topic with their physician. Despite the low levels, physicians do tend to screen systematically, especially when discussing substance use. There is a need to improve physicians training in risk behaviour screening and counselling in order to increase this practice.

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

Cited by 5 publications

References 28 publications

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Wellbeing and mental health interventions for Indigenous children and youth: A systematic scoping review

Far from acceptable: youth-reported risk behaviour screening by primary care physicians

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