Many of us have encountered research that examines the trends of mental health issues during childhood and adolescence. Such studies aim to determine the percentage of the population experiencing mental health problems in their early years, to identify specific sub-groups, and to observe whether individuals with mental health problems show improvement, deterioration, or stability over time. Historically, longitudinal cohort studies like the Dunedin study in New Zealand (Caspi et al., 2020) and ALSPAC in the UK (McElroy et al., 2017) have been fundamental in this field. In 2022, I participated in a study using two longitudinal cohorts in Ireland to track symptom trajectories throughout childhood (Healy et al., 2022). However, a lingering concern among researchers revolves around the accuracy of these cohorts in reflecting real-life scenarios. There’s a chance that individuals in these studies are predisposed to participate or may be influenced by repeated questioning over the years.
The study being reviewed here takes a unique approach by analyzing real-life healthcare data to investigate how young people engage with mental health support services. This study utilizes GP records to assess the actual usage of healthcare services for mental health issues in young individuals.
Methods:
This study utilized the CPRD-Aurum system, which compiles data from 25% of GP practices across England, along with Hospital Episode Statistics and the Office for National Statistics. The sample included patients aged 3-18 who sought help from their GP for a mental health concern between 2000 and 2016. To be included, clinicians must have recorded a mental health symptom or diagnosis in the patient notes during that visit. The study aimed to categorize individuals exhibiting similar patterns of GP visits, prescriptions, and interactions with specialist mental health services over the subsequent 5 years using group-based multi-trajectory modeling.
Results:
A total of 369,340 individuals met the study’s criteria from primary care records. The authors identified 7 groups that best represented different patterns of service use among this sample in the 5 years following their initial visit.
Key Findings:
– Over half fell into group 1, characterized by low GP contact, prescriptions, and specialist service interactions.
– Two groups (6 and 7) showed consistently high prescription rates, making up around 15% of the sample.
– Sex differences in groupings were observed, with females more prevalent in groups 3 and 5 and males majority in group 2.
– Groups 3, 4, and 5 exhibited fluctuations in service use over the 5-year period.
The study also explored whether belonging to specific groups predicted the risk of hospitalization for self-harm or suicide. Most groups showed an increased risk, except for group 3 which displayed a decline in service use over time.
Conclusion:
The findings suggest that over half of children and adolescents seeking help for mental health concerns have low engagement with services. However, interpreting this data poses challenges in distinguishing between improved mental health and disengagement due to unmet needs.
Strengths and Limitations:
The study’s use of real-life primary care data provides robust insights, yet it may not capture the full spectrum of mental health issues due to biases in access and utilization of healthcare services.
Implications for Practice:
This study highlights the potential of routine GP data in predicting the care and treatment trajectories of young individuals with mental health issues.
