Initiation and cessation of mental healthcare after mental health screening in primary care: a prospective cohort study

Christine Geyti, Else-Marie Dalsgaard, Annelli Sandbæk, Helle Terkildsen Maindal, Kaj Sparle Christensen, Christine Geyti, Else-Marie Dalsgaard, Annelli Sandbæk, Helle Terkildsen Maindal, Kaj Sparle Christensen

Abstract

Background: Mental health (MH) problems have considerable personal and societal implications. Systematic MH screening may raise general practitioners' (GP) awareness of the current need of treatment in their listed patients. The focus of MH screening has so far been on increasing diagnostic rates and treatment of mental disorders, whereas cessation of MH treatment after normal test results has rarely been studied. This study aims to examine the mental healthcare trajectories after MH screening combined with feedback on both positive and negative screening results to the GP.

Methods: This prospective cohort study is based on data from 11,714 randomly selected individuals aged 30-49 years, who were invited to a preventive health check in Denmark during 2012-2015. A total of 5970 (51%) were included. MH status was assessed using the SF-12 Health Survey Mental Component Summary score, and scores were categorised into poor, moderate, and good MH. 'Mental healthcare' within 1 year of follow-up covered the following MH support: psychometric testing by GP, talk therapy by GP, contact to psychologist, contact to psychiatrist, and psychotropic medication.

Results: MH was found to be poor in 9%, moderate in 25%, and good in 66% of participants. After 1 year, mental healthcare was initiated in 29% of the participants with poor MH who did not receive mental healthcare at baseline, and mental healthcare was ceased in 44% of the participants with good MH who received mental healthcare at baseline. Odds ratio (OR) for initiation of mental healthcare was associated with worse MH screening status: poor MH: OR 7.1 (5.4-9.4), moderate MH: OR 2.4 (1.9-3.1), compared to those with good MH. OR for cessation of mental healthcare was associated with better MH screening status: good MH: OR 1.6 (1.1-2.6), moderate MH: OR 1.6 (1.0-2.4), compared to those with poor MH. Initiation and cessation of mental healthcare appeared to be time-related to the MH screening.

Conclusions: MH screening combined with feedback on both positive and negative screening results to the GP may contribute to relevant initiation and cessation of mental healthcare.

Trial registration: Registration of the Check Your Health-trial: ClinicalTrials.gov ( NCT02028195 ), 7 March 2014.

Keywords: General practice; Health promotion; Mental health; Mental health screening; Mental healthcare; Preventive health services; Primary healthcare.

Conflict of interest statement

Consent for publication

Not applicable.

Competing interests

The authors declared that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flowchart of inclusion. Participants aged 30–49 years from Randers Municipality, Denmark, recruited from the Check Your Health preventive programme, 2012–2015
Fig. 2
Fig. 2
Initiation of mental healthcare and first contact to GP within 1 year of follow-up. Among participants who did not receive mental healthcare at baseline. Initiation of mental healthcare: a) poor MH (n = 366), b) moderate MH (n = 1260), c) good MH (n = 3776). First contact to GP: d) poor MH (n = 366), moderate MH (n= 1260), good MH (n= 3776)
Fig. 3
Fig. 3
Cessation of mental healthcare within one year of follow-up. Among participants who received mental healthcare at baseline. Good MH (n = 171), moderate MH (n = 218), poor MH (n = 179)

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