Detecting emotional disorder in young people in primary care.
OBJECTIVE
Screening young people for emotional disorder in primary care has seemed sensible given most attend annually and most mental disorder is undetected. Yet evidence supporting screening has been scant. This review considers recent progress around conceptual frameworks, epidemiological findings, accuracy of available instruments and evidence for effectiveness of screening in reducing the burden of emotional disorders.


RESULTS
Despite better evidence about the accuracy of screens in identifying adolescent depression and possible benefits of early intervention with current treatments, demonstration of improved health outcomes and cost-effectiveness is still lacking. Even when screening detects mental disorder other factors such as readiness for care and availability of effective treatments may affect responses. Best results are obtained when screening is linked to collaborative models of care. Evidence around harms from screening is scant but debate exists over potential harms of false-positives such as stigma and increased strain on healthcare resources.


CONCLUSIONS
There is growing consensus that, if screening for emotional disorder is to be effective in primary care, facilitated access of identified young people to effective treatment options is necessary. Further research is required to demonstrate that routine screening will improve mental health outcomes and be cost-effective.
Department of General Practice, University of Melbourne, Australia. l.sanci@unimelb.edu.au
Lena
L
Sanci
Dyani
D
Lewis
George
G
Patton
D000293:Adolescent; D002648:Child; D006801:Humans; D008403:Mass Screening; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D011320:Primary Health Care; D011795:Surveys and Questionnaires