Detection of child mental health problems by general practitioners in a low-resource setting

ObjectiveTo examine the accuracy of general practitioners (GPs) in identifying children with probable mental health problems, and to determine factors associated with accuracy.MethodThis study is a secondary analysis of baseline data from a trial involving 1051 children aged 5-15 years and their parents, recruited from 40 GP practices participating in a collaborative care network in Tehran, Iran. 'Probable mental health problem' was defined by a positive result on the Strengths and Difficulties Questionnaire (SDQ). At the baseline visit, GPs, unaware of SDQ ratings, recorded if they noted any mental health problem in children and indicated the treatments or referrals they had provided. Multilevel regression analyses identified factors associated with GPs' correct detection of children with probable mental health problems.ResultsGPs labeled 311 children (29.7%) as having a mental health problem, and of those, referred 109 for psychiatric consultation. In contrast, the prevalence of 'probable mental health problems' was 35.3% (N = 369). Of children with probable mental health problems, GPs correctly identified 207 (56.1%), while failing to detect 162 (43.9%). In the adjusted regression analysis, correct identification was associated with higher SDQ total score, emotional problem and hyperactivity subscale scores. In addition, parents' poor mental health and a past history of mental health service use were also significantly and independently associated with correct identification of probable mental health problems by GPs.ConclusionsThese findings suggest the need for enhanced training of GPs in Iran, specifically in detecting less severe and less apparent mental health problems among children.