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