Lack of mental well-being in 15-year-olds: an undisclosed iceberg?

BACKGROUND: Young people suffer from psychiatric symptoms and illness, and the frequency of both may be higher than currently is recognized. The frequency with which young people consult GPs with emotional problems is not established. OBJECTIVE: The purpose of this study was to identify the number of 15-year-olds who consult their GP directly or indirectly with psychiatric symptoms or illness. METHODS: A two part survey was carried out involving (i) general practice casenote review; and (ii) questionnaires self-report. The subjects comprised all adolescents aged 15 years from 34 randomly selected general practices and a randomly selected subsample of these adolescents. The main outcome measures were a purpose-designed data collection sheet, General Health Questionnaire (GHQ-12) and a purpose-designed self-report questionnaire. RESULTS: In phase 1, the general practice casenotes of 2359 adolescents were examined. Five per cent of subjects were identified as attending the GP with mental health problems; 1% had attempted suicide during the year. In phase 2, 99 subjects returned completed self-report questionnaires. Although over a quarter (26%) were rated as GHQ-12 'cases' and approximately half reported having felt 'sad, unhappy or low' or 'anxious or worried' in the previous year, only one subject reported attending his/her GP with any of these concerns. CONCLUSIONS: Fifteen-year-olds rarely consult their GP about their emotional well-being, yet, with the GHQ-12, the self-reported rate of psychiatric morbidity was nearly seven times greater than that suggested by these same subjects' medical records. Although the majority of adolescents consult their GP throughout the course of a year, those with mental health problems, including those who attempt suicide, are indistinguishable in the frequency of their GP consultations from adolescents without mental health problems.