Abstract
BackgroundDue to a large strain on youth mental health care, general practice is suggested as an alternative treatment setting for children and adolescents with anxiety problems. However, research on the current management of these children and adolescents within general practice is scarce.AimTo investigate the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC), and GPs’ management of children and adolescents presenting with anxiety problems.Design and settingPopulation-based cohort study using electronic medical records of 51 212 children (aged 0–17 years) in primary care in the Rotterdam region between 1 January 2012 and 31 December 2018.MethodIncidence of ICPC codes for anxiety were calculated, then the characteristics of children and adolescents consulting their GP with anxiety and the GPs’ management were assessed qualitatively using quantitative content analysis.ResultsIncidence of ICPC codes for anxiety in children and adolescents was 5.36 (95% confidence interval [CI] = 5.02 to 5.71) per 1000 person–years. Adolescent females had the highest incidence with 14.01 (95% CI = 12.55 to 15.58) per 1000 person–years. Of the 381 children and adolescents consulting their GP with an initial anxiety problem (median age 13.3 years, 40.4% male), GPs referred 59.3% to mental health care in the first year while 26.5% of children and adolescents were managed by a specialised practice nurse within general practice. Of the 381 children and adolescents, 10.5% received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence.ConclusionIn general practice children and adolescents frequently received one of two ICPC codes for anxiety, especially adolescent females. Most presenting to their GP with anxiety problems are referred externally or seen by a specialised practice nurse within general practice.
Highlights
Of the 381 children consulting their GP with an initial anxiety problem, GPs referred 59.3% to mental healthcare in the first year and 26.5% of children were managed by a specialised practice nurse within general practice. 10.5% of children received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence
This study shows that children in general practice in the Netherlands frequently receive an International Classification of Primary Care (ICPC) code for anxiety
The highest incidence rate of 14.01 per 1000 persons-years at-risk (PYAR) was in adolescent girls
Summary
Anxiety disorders form the most common mental health problem in children and adolescents and cause significant burdens .(1) A recent meta-analysis estimated the global prevalence of anxiety disorders among children and adolescents at 6.5%.(2) Anxiety disorders have significant negative effects on quality of life and the overall development of affected children and their of kin,(3-6) and are associated with an increased risk of suffering from mental health disorders in adulthood.[710]Despite the existence of effective treatments,(11-13) paediatric anxiety disorders seem underrecognized and undertreated.[14,15,16,17,18,19,20] Factors like stigmatization, financial costs, or limited access to services (e.g. waiting-lists) form major barriers to appropriate care.[21]. Aims: To investigate 1) the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC) and 2) general practitioners’ (GPs) management of children presenting with anxiety problems. Results: The incidence of ICPC codes for anxiety in children was 5.36 per 1000 persons-years. Of the 381 children consulting their GP with an initial anxiety problem (median age: 13.3 years, 40.4% male), GPs referred 59.3% to mental healthcare in the first year and 26.5% of children were managed by a specialised practice nurse within general practice. Conclusion: In general practice children frequently receive one out of two ICPC codes for anxiety, especially adolescent girls. This study shows that children in general practice in the Netherlands frequently receive an ICPC code for anxiety. A quarter of these children are seen within general practice by a specialized practice nurse
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