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Abstract
BackgroundGPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people’s reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care.MethodsWe conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project’s Exit Interview.ResultsOf the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care.ConclusionsWe conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care.Trial registrationClinicalTrials.gov NCT00794222
Highlights
General Practitioners (GPs) detect at best 50c of mental health problems in young people
This paper reports on the health service outcomes of the RCT, the following questions were investigated: i) To what extent does the mobiletype function as a clinical assistance tool for GPs in their assessment and management of mental health symptoms in young people compared with an attention-comparison, ii) does the mobiletype program enhance doctor-patient rapport compared to an attention-comparison, iii) and does the mobiletype program assist in leading young people into pathways to care for mental health symptoms compared to an attention-comparison?
The present paper focuses on a selection of participant and GP variables pertaining to mobiletype as a clinical assistance tool, GP/ patient rapport, and pathways to care
Summary
GPs detect at best 50c of mental health problems in young people. As General Practitioners (GPs) are the gatekeepers of mental health care [3], and most adolescents see a GP at least once a year [4], GPs are in an ideal position to identify young people at need or those who would benefit most from early intervention. It is estimated that GPs are only identifying 50% of patients with mental health disorders [5,6]. The majority of young people prefer to seek help from family and friends for mental health problems rather than general practitioners [7]. Patient-doctor rapport plays a large role in a young person’s willingness to discuss general and mental health concerns with their GP [9] and necessarily better detection rates of youth mental health problems are associated with this rapport [6]
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