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Mental Disorders Among Young Adults Self-Referred and Referred by Professionals to Specialty Mental Health Care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
2009 (English)In: Psychiatric Services, ISSN 1075-2730, E-ISSN 1557-9700, Vol. 60, no 12, 1649-1655 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Psychiatric disorders among young adults are prevalent, although a minority seek treatment. The option of direct self-referral to specialty mental health care may lower the help-seeking threshold but may also lead to self-referral by those with symptoms but no diagnosable disorders. This study examined whether differences exist in morbidity and in past use of mental health services between self-referrals to specialty care and those referred by nonpsychiatrist professionals. METHODS: Two hundred consecutive young adult outpatients from a medium-sized city in Sweden who visited a specialty psychiatric clinic were assessed with the Structured Clinical Interview for DSM-IV (axis I and II disorders). Previous mental health contacts were also assessed. RESULTS: A total of 49 patients (25%) were self-referred and 151 (75%) were referred by nonpsychiatrist professionals. Mood disorders and specific phobia were more common among self-referred patients (p<.05 for both), but no other significant between-group differences in axis I or II disorders were found. No differences were found in number of current axis I disorders (2.3 for self-referred and 2.2 for the comparison group), number of lifetime diagnoses (2.9 and 2.9), self-reported age at onset (13.6 and 13.5 years), and GAF ratings (54.5 and 54.7). The proportion of patients with no previous mental health contacts was larger in the self-referred group (35% and 18%, p<.05). CONCLUSIONS: No evidence was found that the option of direct self-referral to specialty mental health care increased help seeking or led to overuse of care, although the generalizability of findings to other settings is unknown.

Place, publisher, year, edition, pages
2009. Vol. 60, no 12, 1649-1655 p.
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-122829DOI: 10.1176/appi.ps.60.12.1649ISI: 000272273300013PubMedID: 19952156OAI: oai:DiVA.org:uu-122829DiVA: diva2:311128
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Young Adults in General Psychiatry
Open this publication in new window or tab >>Young Adults in General Psychiatry
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mental illness is common, and usually starts early in life. However, the majority of those affected never seek mental health care. The overall aim of this thesis was to increase knowledge about help-seeking young adults with mental illness in order to improve diagnostic procedures in clinical psychiatry.

A group of young adult psychiatric out-patients (n=217) were consecutively invited to participate in the study between October 2002 and September 2003. Altogether 200 (92%) agreed to participate. Among them, there were 161 (80%) women and 39 (20%) men. Participants’ mean age was 22.4±1.9 years. All participants were carefully and comprehensively assessed with respect to axes I, II, IV and V in the DSM-IV. Psychiatric disorders and personality disorders were assessed using the Structured Clinical Interview for DSM-IV for axis I disorders and the Structured Clinical Interview for DSM-IV for axis II disorders. Psychosocial and environmental problems (axis IV) were evaluated through structured interviewing by a social worker and by self-assessment with a questionnaire. Professional and patient ratings on the Global Assessment of Functioning scale were compared before and after treatment. Patients also reported on the Swedish universities Scales of Personality, the Child and Adolescent Psychiatric Screening Inventory-Retrospect and the Coddington’s life event scale.

Taken together, the young adult, psychiatric outpatients were characterized by an early onset of their mental disorders, by co-morbidity, by being female and by having mood or anxiety disorders. There were no significant differences between self-referred and those referred by medical professionals according to either number of current or lifetime diagnoses. Childhood onset of depression was associated with more severe symptoms, more psychosocial risk factors, and more childhood developmental delays. Axis IV psychosocial stress categories were related to the presence of axis I disorders, personality disorders, co-morbidity, and impaired functioning. Agreement between patients’ and professionals’ ratings on the GAF scale was good before treatment and excellent after treatment.

In summary, the findings suggest that direct self-referral to specialized psychiatric care does not seem to be associated with overutilization of such care. Childhood onset of depression is associated with a more complex illness. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability. And finally, the results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 48 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 671
Keyword
Young adults, multi-axial diagnostics, self-referred, help seeking, axis IV, axis V
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-151504 (URN)978-91-554-8070-7 (ISBN)
Public defence
2011-05-28, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-05 Created: 2011-04-12 Last updated: 2011-07-01Bibliographically approved

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