GP follow-up after first diagnosing psychological problems among adolescents: A nationwide register-based study

Abstract

Background Psychological problems are common among adolescents. Many GPs consider these problems challenging, even after diagnosis. Aim To explore how Norwegian GPs follow-up patients after a first diagnosis of a psychological problem at age 15-16 years. Design and setting Nationwide longitudinal, register-based study using claims data for all GPs in the national list patient system, and for adolescents born in 1993 and 1994 (n = 129 499). Method National databases and registers were used to determine how many adolescents received a first diagnosis of a psychological problem in a GP consultation at age 15 or 16 years. Further consultations, collaborative contacts in primary care, and referrals to secondary care during the year after diagnosis were then identified and used as outcomes in regression analyses to investigate associations with initial diagnosis, parental education, and GP characteristics. Results In total, 6809 (5.3%) adolescents received a first diagnosis of a psychological problem in a GP consultation at age 15 or 16 years. Internalising problems constituted 50.5% of initial diagnoses among females and 28.8% among males. Behaviour and attention problems accounted for 21.3% for females and 45.0% for males. In total, 46.6% of females and 39.9% of males had ≥1 follow-up consultation, and 32.8% of females and 27.0% of males were referred to secondary care. GPs reported primary care collaboration for 22.1% of females and 19.1% of males. GPs with larger patient lists had higher referral rates, but collaborated less within primary care. Males with a male GP had more follow-up consultations than males with a female GP. Conclusion GP follow-up after diagnosing psychological problems among adolescents is limited, but predominantly comprised referrals and some multidisciplinary cooperation. GP followup consultations should be studied more thoroughly, and the role of GPs warrants further policy discussions.