Consultation for and identification of child and adolescent psychological problems in Dutch general practice

Abstract

BACKGROUND: Child and adolescent psychological problems are rarely brought to the attention of GPs. Children and adolescents with psychological problems who do visit their GP are seldom identified as such by GPs. OBJECTIVE: To investigate in a general population sample of 2,449 Dutch children and adolescents (4-17 years) GP consultation and GP diagnoses of child psychological problems, and the influence of child and family characteristics upon these variables. METHODS: The degree to which parent, teacher, and adolescent reports of the presence of child psychological problems are in concordance with GP diagnoses of these problems was determined. Logistic regression analyses were used to examine correlates of GP consultation and psychological diagnoses. RESULTS: Approximately 80% of children and adolescents with psychological problems had visited their GP within the preceding year. GP consultation was most strongly associated with child/adolescent chronic physical disorders. Concordance between GP psychological diagnoses and parent, teacher, and adolescent reports of psychological problems was limited. Children and adolescents with psychological problems according to parent or teacher report, children with school problems, young boys, adolescents with negative health perceptions, and adolescents from single parent families were more likely to be diagnosed with psychological problems by GPs. CONCLUSION: Improving GPs' interview techniques, introducing standardised screening measures in general practice, increasing GPs' awareness of the possible presence of psychological problems in children consulting for physical problems, and strengthening collaboration between GPs and mental health professionals may increase GP identification of child psychological problems and enhance access to care for those in need.

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