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General practice / Family practice
Original research
Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office
  1. Ole Rikard Haavet1,
  2. Jūratė Šaltytė Benth2,3,
  3. Svein Gjelstad1,
  4. Ketil Hanssen-Bauer3,4,
  5. Mina Piiksi Dahli1,
  6. Nick Kates5,
  7. Torleif Ruud3,4
  1. 1Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
  2. 2Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
  3. 3Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  4. 4Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway
  5. 5Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Professor Ole Rikard Haavet; o.r.haavet{at}medisin.uio.no

Abstract

Background Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions.

Aim To investigate whether shared care with mental health professionals in GP offices increases the detection of youth’s mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician.

Design and setting This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3–8 GP offices. One GP office was randomised to the intervention group and the other to the control group.

Method We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth.

Results Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients’ regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm.

Conclusion Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient’s regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group.

Trial registration number NCT03624829; Results.

  • general medicine (see internal medicine)
  • depression & mood disorders
  • anxiety disorders
  • child & adolescent psychiatry

Data availability statement

Data are available upon reasonable request. The dataset analysed in the current study is available from the principal investigator (TR) on reasonable request.

Data availability statement

The dataset analysed in the current study is available from the principal investigator (TR) on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-050036

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    Data availability statement

    Data are available upon reasonable request. The dataset analysed in the current study is available from the principal investigator (TR) on reasonable request.

    Data availability statement

    The dataset analysed in the current study is available from the principal investigator (TR) on reasonable request.

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    Footnotes

    • Contributors ORH is responsible for the overall content. ORH, JŠB, SG and TR had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. MPD and ORH recruited the GP offices and did the physical extraction of electronic medical data from the different GP office centres. ORH, SG, MPD, KH-B, NK and TR contributed to the plan and design of the study. ORH, SG and JŠB performed the data analyses. ORH drafted the manuscript and was together with TR in charge of the study planning. All authors have revised the manuscript critically for important intellectual content, and have given final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None

    • Ethics approval statement This cluster-randomised study was registered in ClinicalTrials.gov, Results (NCT03624829) and obtained the necessary approvals from The Regional Committee for Medical and Health Research Ethics South-East (REC, reg. no. 2014/435), The National Committee for Medical and Health Research Ethics (NEM, reg. no. 2014/160) and the Data Protection Officer at Akershus University Hospital (reg. no. 2013-138).

    • Provenance and peer review Not commissioned; externally peer reviewed.