Brief mental health screening questionnaire for children and adolescents in primary care settings.

UNLABELLED: Early detection of mental health problems is important. The implication of primary care professionals and the adequacy of instruments could be of great help. OBJECTIVE: To study the validity of a brief questionnaire based on psychosocial functioning to detect mental health problems in a high-risk general population. STUDY GROUP: 151 children and adolescents were assessed as part of a longitudinal 3 year follow-up study of two cohorts born in 1989 and 1993, respectively. METHOD: semi-structured diagnostic interviews were used to evaluate their psychopathological condition, to test for functional impairment, and to determine whether it would be appropriate for them to be referred to Mental Health Services. Parents also answered a Brief Mental Health Screening Questionnaire (BMHSQ) containing questions about main psychosocial functioning areas. Logistic and multiple regressions were applied to study the predictive power of the questionnaire. RESULTS: The BMHSQ showed good clinical screening properties and was useful in determining who should be addressed to a specialized psychopathological service. CONCLUSION: General practitioners could play an essential role in detecting and referring such disorders if provided with the proper tools. The use of brief questionnaires on functioning and outcomes in pediatric practice could improve comprehensive health care for children and adolescents. Rapid detection of mental health problems in a primary care setting is possible, as is better use and planning of health services.

What single reports from children and parents aggregate to attention deficit-hyperactivity disorder and oppositional defiant disorder diagnoses in epidemiological studies.

OBJECTIVE: To analyze information on attention deficit-hyperactivity disorder (ADHD)-oppositional defiant disorder (ODD) and its consequences, provided separately or in combination by children and their parents in a longitudinal prospective study of 9-15 year-old children from the general population. METHOD: Cross-sectional and longitudinal epidemiological indexes were compared for single and multiple reports. We evaluated which informant is required for the identification of each DSM-IV criterion. Logistic regressions determined which features were related with the reporting of the "absence" of symptoms. RESULTS: Both informants were required in order to obtain complete psychopathological profiles. Single reports provide infra-estimated prevalences (between 8.8 and 22.9% of ADHD and between 1.7 and 7.6% of ODD), risks (around 3% for ADHD and 2% for ODD) and comorbidities. Psychological and functional measures analyzed in the study were relatively similar for cases presenting ADHD/ODD diagnosis, regardless of the diagnostic algorithm (based on single or combined reports); however, these clinical profiles were different to those obtained for non-diagnosed children. The main predictors of not reporting the presence of psychopathology were: large families (OR between 2 and 2.5), children that are conflictive at school (OR ranging between 1.3 and 4.3) or those with poor mental health (OR between 1.1 and 1.6). CONCLUSIONS: These results may provide guidance for obtaining accurate diagnostic information, properly identifying children with mental health needs and planning the required preventive and corrective measures.

Features associated with the non-participation and drop out by socially-at-risk children and adolescents in mental-health epidemiological studies.

OBJECTIVE: To study socio-demographic and functional features related with non-collaboration in a longitudinal design of mental health within a high-risk population of individuals 9 and 13 years old. METHOD: Regression analyses were used to assess factors affecting the decision to decline participation, and what characteristics both of children and families increase the probability of dropping out once the study had already started. RESULTS: Refusal of participation at the outset is more probable for lower socioeconomic groups, unemployed families (or with Social Security benefits), minority cultures and children having low school performance. The risk of participants dropping out is higher for adolescents, those who need help at school, are unhealthy, have more life-events, receive professional help for mental problems or have had more psychopathology in previous assessments. Lengthy interviews or evaluations without the return of reports to families are also predictive of drop out. CONCLUSIONS: This study has practical implications for reducing the lack of collaboration in the prospective studies that assess mental health in children and adolescents. Improvement in the estimation of epidemiological indices requires the planning of special measures for research projects carried out on populations with fewer resources so as to recruit individuals with lower SES, adolescents, individuals with pathologies (physical or psychological) and those with lower levels of school achievement.