Treading a fine line: is diagnosing depression in young people just medicalising moodiness?

Iliffe, Steve; Williams, Georgina; Fernández, Victoria; Vila, Mar; Kramer, Tami; Gledhill, Julia; Miller, Lisa

doi:10.3399/bjgp09x407081

Cited by 21 publications

(15 citation statements)

References 18 publications

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“…A quest for certainty in areas of complex practice, especially when it concerns individual experiences, can be counterproductive and scholars have cautioned against clinging to the ‘shelter of diagnosis’15 when what is required involves attention to alleviating suffering and working purposefully with patients to catalyse their own creative capacity 14. Iliffe et al 's32 33 earlier cited work demonstrated that when GPs were fixed on the concept of depression as disease, they were uncomfortable talking to young people.…”

Section: Discussionmentioning

confidence: 99%

“I think this is maybe our Achilles heel…” exploring GPs’ responses to young people presenting with emotional distress in general practice: a qualitative study

2013

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ObjectiveAn exploratory study to investigate general practitioners’ (GPs’) views and experiences of consulting with young people (aged 12–19 years) presenting with emotional distress in general practice.DesignA qualitative study using grounded theory and situational analysis. Empirical data were generated through in-depth interviews based on a topic guide developed from the literature, and augmented with a series of situational maps. Continuous field notes and theoretical memos were recorded during data collection and analysis.The data were analysed using the constant comparative method of grounded theory. There were three levels of analysis. The first level developed the open codes and is presented here.Setting18 general practices located in the north east of England. The practices recruited included rural, urban and mixed populations of patients who were predominantly living in socioeconomically disadvantaged communities.Participants19 GPs (10 women) aged between 29 and 59 years participated. The modal age range was 40–49 years. Theoretical sampling was used to guide recruitment and continued until theoretical saturation was reached.ResultsThe overarching finding was that anxiety about practice dominated clinical consultations involving young people presenting with emotional distress. GPs responded differently to anxiety and to related uncertainties about professional practice, independent of GP age or gender. Anxiety occurred in the consultation, at an external level, across disciplinary boundaries, in relation to communication with young people and secondary to the complexity of presentations.ConclusionsAdolescent emotional distress presents professional challenges to GPs who feel ill-equipped and inadequately prepared to address early need. Medical education needs to prepare doctors better. More research is needed to look at what factors facilitate or prohibit greater GP engagement with emotionally distressed young people.

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Section: Discussionmentioning

confidence: 99%

“I think this is maybe our Achilles heel…” exploring GPs’ responses to young people presenting with emotional distress in general practice: a qualitative study

2013

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“…Accurate diagnosis and appropriate management is complicated by a tendency for young people to present with physical rather than psychological problems 19 and by less specific and atypical clinical presentations occurring more commonly than classic melancholic presentations 25 26 . This is highlighted by studies which indicate that mental disorders are the presenting complaint of as little as 2% of all presentations 27 . Similarly, a questionnaire study of 13-16 year-olds attending general practice found two per cent had presented with psychiatric complaints, yet 38% had experienced a psychiatric disorder 28 .…”

Section: General Practice Has a Role In Addressing Youth Mental Healthmentioning

confidence: 99%

“…In a review of 3934 children aged 4-15 who were recognised by GPs to have psychosocial problems, Gardner et al found standardised assessment tools had been used in only 20% GPs spend less time in consultations with young people 45 , do not always explore psychological problems in young people for fear of over-medicalising their experience 46 and a specific management or follow-up plan is identified in only a minority of cases 22 . By way of explanation, others have highlighted the dangers of normalising emotional distress in adolescents 27 , emphasizing that 75% of young people do not display major emotional distress during their teens 47 . Psychosocial formulations can inform our understanding of the factors that underpin emotional disturbances but this should not be to the exclusion of appropriate psychological and biological treatment.…”

Section: Detection and Treatment By Gpsmentioning

confidence: 99%

What is the role of general practice in addressing youth mental health? A discussion paper

et al. 2011

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Background. Mental and substance use disorders are a leading cause of morbidity among young people. Policy and clinical services in Ireland are endeavouring to address theses twin issues.Aims. To review the emerging literature on the role of general practice in addressing youth mental health and to discuss the implications of this literature for further research, education and service delivery.Methods. We conducted a review of 'PubMed' and a web search of relevant national / international primary / mental healthcare agencies and professional bodies.

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“…If GPs perceive that young patients have psychological problems they do not always explore these and follow-up or a management plan is set up for only a minority (Iliffe et al, 2009).…”

Section: Suicide Prevention In Primary Carementioning

confidence: 99%

Suicidal students’ use of and attitudes to primary care support services

Stanley

Mallon

Bell

et al. 2010

Primary Health Care

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The aims of this study were to improve responses to students in distress and who are feeling suicidal, to help practitioners to increase their responsiveness to those at high risk of suicide and to develop effective responses to those affected by their deaths. The study sought to build a detailed picture of students' patterns of service use. Background: National suicide prevention strategies emphasise that suicide prevention requires the collaboration of a wide range of organisations. Among these, primary care services play a key role in relation to suicide prevention for young people in crisis. Methods: This study, undertaken between 2004 and 2007, focused on 20 case studies of student suicide that took place in the United Kingdom between May 2000 and June 2005. It adopted a psychological autopsy approach to learn from a wide range of informants, including parents, friends, university staff and the records of coroners or procurator fiscals. Twenty families gave permission for their son's or daughter's death to be included in the study and agreed to participate in the study. Informants were interviewed in person and the data were analysed thematically. Analysis of the case study data suggested that in a number of cases students had failed to engage with services sufficiently early or in sufficient depth. Primary care practitioners need to be proactive in communicating concerns about vulnerable students to student support services. At local levels, collaboration between student support and National Health Service practitioners varied considerably and channels of communication need to be developed.

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Treading a fine line: is diagnosing depression in young people just medicalising moodiness?

Cited by 21 publications

References 18 publications

“I think this is maybe our Achilles heel…” exploring GPs’ responses to young people presenting with emotional distress in general practice: a qualitative study

“I think this is maybe our Achilles heel…” exploring GPs’ responses to young people presenting with emotional distress in general practice: a qualitative study

What is the role of general practice in addressing youth mental health? A discussion paper

Suicidal students’ use of and attitudes to primary care support services

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