Research report
Interventions that are helpful for depression and anxiety in young people: A comparison of clinicians' beliefs with those of youth and their parents

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Abstract

Background

The aim of the research was to assess the consensus of clinicians about the appropriate treatments for depression and anxiety in youth, to discover any major differences between clinicians' beliefs and those of young people and their parents, and to assess whether clinicians' beliefs were consistent with clinical practice guidelines for young people.

Methods

Postal surveys were carried out on the beliefs of Australian general practitioners, psychiatrists, psychologists, and mental health nurses about what are helpful interventions for depression and social phobia in a 15-year old and in a 21-year old. The clinician data were compared to findings from an earlier national survey of Australian youth aged 12–25 years and their parents.

Results

The clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive-behavior therapy, counseling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for depression in a 21-year old. Young people and their parents showed much lower endorsement than clinicians of antidepressants and cognitive-behavior therapy, while clinicians had much lower endorsement than the public of informal supports such as family, friends and support groups.

Limitations

The survey was adapted from one designed for the public and did not allow clinicians to express complex opinions.

Conclusions

Clinicians show substantial consensus about appropriate treatments. However, there are some major differences in beliefs between clinicians and young people, which may be a barrier to optimal help-seeking.

Introduction

There are studies from a range of countries looking at the depression and anxiety treatment preferences of members of the general public or of depressed patients seen in primary care. These studies generally show that the public have a positive view about counseling and psychological treatment, but a negative one about antidepressants, which are seen as potentially harmful, addictive and not solving the underlying problem (Angermeyer et al., 1993, Fischer et al., 1999, Goldney et al., 2001, Jorm et al., 1997, Jorm et al., 2005, Priest et al., 1996, Van Schaik et al., 2004). Such beliefs may have an effect on the uptake and adherence to recommended treatments and may contribute to the low rate of seeking treatment for common mental disorders (Andrews et al., 2001).

Previous research on this topic has been with adults. However, common mental disorders often have their first onset during adolescence or early adulthood (Oakley Browne et al., 2006). Knowledge about potential help-seeking and treatment options is important at the age of first onset, but this may be an age where relevant experience and knowledge are lacking. Particularly for adolescents, parents can play an important role in mediating help-seeking, but they may have limited knowledge as well. Recently, Jorm and Wright (2007) reported a national survey of Australian youth aged 12–25 years and their parents, which assessed their beliefs about the effectiveness of a wide range of interventions for mental disorders. Both young people and their parents were found to prefer informal and general sources of help for depression and social phobia over specialist mental health services. Only a minority believed that antidepressants and cognitive-behavior therapy would be helpful.

These findings suggest that there may be some major discrepancies between young people and their parents and clinicians in beliefs about treatments. We have therefore supplemented the survey of youth and parents with a survey of four groups of Australian clinicians: general practitioners (GPs), psychiatrists, psychologists and mental health nurses. The aim of these clinician surveys was to find out the consensus of clinicians about the appropriate treatments for this age group, to discover any major differences between clinicians' and public beliefs, and to assess whether clinicians' beliefs were consistent with clinical practice guidelines for young people.

Section snippets

Clinician samples

Here we report on a subset of the entire survey sample, which also included clinicians who received psychosis vignettes (refer to Lubman et al. (2007) for details of the entire sample). Surveys were posted to 1282 psychiatrists listed on the Medicare Provider File (Medicare is Australia's national health insurance scheme), a random sample of 1500 GPs listed on the File, 1221 Australian members of the Australian and New Zealand College of Mental Health Nurses, and a random sample of 1500

Differences across clinical professions

When logistic regression was used to examine predictors of helpfulness ratings, a number of significant differences were found. When compared to GPs, psychiatrists were more likely to recommend psychiatrist (OR = 4.41, P < 0.001), sleeping pills (OR = 2.72, P = 0.005), and psychiatric ward (OR = 2.24, P = 0.002); and less likely to recommend GP (OR = 0.39, P = 0.001), teacher/lecturer (OR = 0.53, P < 0.001), counselor (OR =0.28, P < 0.001), telephone counseling (OR = 0.53, P < 0.001), family (OR = 0.55, P < 0.001), friend (OR

Consensus of clinicians about treatments

The clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive-behavior therapy, counseling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for depression in a 21-year old. The recommendations were the same whether or not depression was co-morbid with alcohol misuse. There was also substantial overlap in recommendations for depression and social phobia, the main

Role of funding source

Funding was provided by the National Health and Medical Research Council, the Colonial Foundation and “beyondblue: the national depression initiative”. These funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflicts of interest

No conflict declared.

Acknowledgements

Claire Kelly, Robyn Langlands, Betty Kitchener and Len Kanowski had input into the survey content. Darren Pennay and Graham Challice from the Social Research Centre provided advice on survey methodology. Funding was provided by the National Health and Medical Research Council, the Colonial Foundation and “beyondblue: the national depression initiative”.

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