The identification of young people's emotional distress: a study in primary care

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.