Primary Care Docs Often Don't Screen for Mental Illness

By MacReady, Norra | Clinical Psychiatry News, October 2004 | Go to article overview

Primary Care Docs Often Don't Screen for Mental Illness


MacReady, Norra, Clinical Psychiatry News


Only half of the primary care physicians responding to a recent survey said they routinely screen their adolescent patients for mental illness and always ask them about their mental health.

The doctors surveyed gave many reasons for their failure to screen for mental illness, including scarce resources, time constraints, and reluctance to stigmatize their patients.

But most of the participants admitted that they didn't feel confident about their knowledge of psychiatric disorders: 82% of the 506 doctors surveyed rated their knowledge base of adolescent mental health issues as good or somewhat good, compared with 13% who rated their knowledge as excellent, and 5% who considered it weak, said Daniel Romer, Ph.D., lead author of the survey, which was presented at a summit on adolescent mental health disorders in Rancho Mirage, Calif.

The summit, sponsored by the Annenberg Foundation Trust at Sunnylands, launched a national effort to increase the diagnosis and treatment of adolescent mental disorders.

The doctors were surveyed in 25-minute telephone interviews conducted from September to December 2003. The sample was drawn from the American Medical Association's master list of physicians and consisted of 80% pediatricians and 20% family and general physicians, in proportion to their estimated use by adolescents.

"I was somewhat surprised that [the doctors] were as uncomfortable [with these issues] as they reported," Dr. Romer told this newspaper.

Those findings help explain why less than half of the 4 million American adolescents with serious mental disorders receive treatment of any kind, and why the treatment they do receive is often inadequate, Dr. Dwight Evans, chair of psychiatry at the University of Pennsylvania, Philadelphia, said in a press release about the summit.

"Most doctors do not feel very capable of identifying mental disorders," Dr. Romer and his colleagues wrote in a preliminary analysis of the data.

Of the participants, 91% of them expressed interest in continuing education courses that dealt with adolescent mental health issues.

To some extent, doctors' confidence in their ability to identify certain mental disorders depended on the disorder in question. Many more physicians reported feeling "not too capable" of identifying schizophrenia, and bipolar disorder than they did of identifying depression, anxiety, eating disorders, and substance abuse. A fairly large percentage described themselves as "not too capable" of identifying sexual abuse. (See chart.)

On a brighter note, said Dr. Romer, research director of the Adolescent Risk Communication Institute at the Annenberg Public Policy Center at the university, 78% of the doctors surveyed said they did feel comfortable discussing mental health issues with adolescents and 75% viewed such discussions as part of their job.

That's important, because "national youth risk behavior data tell us that 1 adolescent in 4 thinks about suicide each year, and by the end of high school, at least 1 in 10 had made at least one suicide attempt," Dr. …

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