Analyzing User-Generated Web-Based Posts of Adolescents' Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis.

BACKGROUND: Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking. OBJECTIVE: This study aimed to fill this knowledge gap through a new understanding of adolescents' cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice. METHODS: The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression. RESULTS: Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts. CONCLUSIONS: These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action.

An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway.

BACKGROUND: Effectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers. METHODS: In this retrospective cohort study, we looked at 12 months of data from electronic health records from six GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency. RESULTS: We found that 4.6% of all GP patients and 18.4% of the GP patients with a mental health problems were treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers. CONCLUSIONS: Men were more likely to be treated in SMHC centers than women, which may imply that they have different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care.

Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice.

Objective: To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice.Design: A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practicesSetting: Six GP group practices in Groruddalen, Norway.Subjects: All patients aged 16-65 with a registered contact with a GP during 12 months in 2015.Main outcome measures: Frequency and distribution of psychological diagnoses made by GPs, and the number of patients' consultations.Results: GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (p<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs.Conclusions: Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex.Implications: The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population.Key PointsEighteen percent of patients aged 16-65 in our study of patients in urban general practice received one or more psychological diagnoses in 12 months.Depression was the most common diagnosis; followed by acute stress reaction, anxiety and sleep disturbance.Patients with psychological diagnoses had a significantly higher mean number of consultations compared to patients without such diagnoses regardless of age and sex.

Somatic symptoms in children who have a parent with cancer: A systematic review.

BACKGROUND: This systematic review explored the occurrence and types of somatic symptoms in children (0-20 years) who have experienced parental cancer. METHODS: We complemented a systematic literature search from PubMed and PsycInfo with a reference search. We identified 1,694 articles, which were independently screened by two authors; they further evaluated potentially relevant papers for quality and extracted the data. We found nine relevant studies (10 publications) on altogether 672 children with a parent who had cancer; four studies included a control group. RESULTS: The studies typically focused on children's psychosocial reactions on parental cancer rather than somatic complaints, so symptom prevalence cannot be reliably summarized. Several studies were small, and the types of somatic symptoms were only specified in five studies. Somatic symptoms were reported as a measure of emotional reactions in the remaining four studies. Three studies provided longitudinal data. The main types of specific symptoms reported were eating problems, pain, sleeping troubles, and bed-wetting. Children of cancer patients tended to show an increase of unspecified somatic symptoms and pain, but evidence was inconsistent. There was a tendency that somatic complaints were associated with increased emotional distress in the children. The material did not allow for separate analysis by age group or bereavement status. CONCLUSIONS: Children in families with parental cancer may present with somatic complaints, but the prevalence and significance is not possible to estimate due to very sparse research in this area. Health professionals or counselling providers should not overlook this possible sign of distress. Qualitative studies report significant health anxiety in these children; this may represent a specific topic for counselling in this population. Targeted studies are needed to evaluate the prevalence and significance of somatic symptoms, and especially vulnerable groups need to be identified.

International variation in programmes for assessment of children's neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function.

BACKGROUND: Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. FINDINGS: Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. CONCLUSIONS: Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.

Social participation in young people with nonepileptic seizures (NES): A qualitative study of managing legitimacy in everyday life.

This qualitative study explored social participation in young people with nonepileptic seizures (NES), particularly how legitimacy of illness is managed in everyday life. Young people with NES, all female and aged between 14 and 24 years (N=11), were interviewed and followed up over a 14-month period. The transcripts were analyzed using thematic analysis. Four main themes were elaborated: 1) Delegitimizing experiences from families, schoolteachers, colleagues, and employers were part of everyday life. 2) Fear of being exposed to delegitimizing events resulted in the young people trying to conceal the diagnosis; for some, this resulted in isolation from all social arenas, apart from their closest relationships. 3) Support from close relationships was protective against delegitimization and contributed towards greater social participation. 4) Perceiving NES as a legitimate disorder contributed to increased social participation. We found a relationship between legitimacy of illness experienced by the participants and the extent to which they either participated or retreated socially. Those who had an illness perception that was personally meaningful experienced their condition as being more legitimate and participated more socially.

Validation study of HSCL-10, HSCL-6, WHO-5 and 3-key questions in 14-16 year ethnic minority adolescents.

BACKGROUND: There is a lack of validated instruments for detection of depression in ethnic minority adolescent patients in primary care. This study aimed to compare a subgroup of the bilingual, ethnic minority adolescents with the rest of the population using Hscl-10, Hscl-6, WHO-5 and 3-Key Questions for detection of depression in primary care. METHOD: This is a cross-sectional, multicenter study conducted in General Practice in Norway and Denmark. A minor bilingual non-aggregated heterogenic ethnic minority group from non-European countries was compared with a major ethnic group of Norwegian/Danish adolescents. Participants completed questionnaires which were either mailed to them or found on our website. The Composite International Diagnostic Interview was used as gold standard. Depression classified by the International Classification of Diseases - 10. The Internal and external validity of the four questionnaires were examined. Optimal cut-off point for major depressive disorder was calculated using the Youden Index. RESULTS: 294 (77%) were interviewed; mean age was 15 years. The ethnic group comprised 44 (64% girls and 36% boys). Chronbach's alpha was above 0. 70 and area under curve was 0.80 or above for all instruments in the ethnic minority group. Cut-off points for major depressive disorder had sensitivities of 81% (Hscl-10), 82% (Hscl-6), 91% (Who-5) and 81% (3-key questions) in the ethnic minority group. Corresponding specificities were 80% (Hscl-10), 77% (Hscl-6), 80% (Who-5) and 67% (3-key questions). Cut-off points were the same Hscl-10, Who-5, the 3-key questions but differed for Hscl-6. CONCLUSION: Hscl-10, Hscl-6, WHO-5 and 3-key questions seem to be valid instruments for detection of depression in bilingual, ethnic minority adolescents in primary care.

Diagnosis of depressed young people--criterion validity of WHO-5 and HSCL-6 in Denmark and Norway.

BACKGROUND: According to the World Health Organization, depression ranks as a major contributor to the global burden of disease. A large proportion of adult depressions had their first appearance in adolescence. Brief and reliable rating scales are needed for early detection. OBJECTIVE: The aim of this study is to validate the WHO-5 and the HSCL-6 for detection of depression among adolescents. METHODS: The project is a GP multicentre study conducted in Denmark and Norway. A total of 294 adolescents (14-16 years) responded by answering a paper- or web-based questionnaire and later completed a Composite International Diagnostic Interview, which was used as the gold standard. Depression was defined by ICD-10 criteria. Criterion validity was examined, the likelihood ratios measured and cut-offs for depression were calculated using the Youden index. RESULTS: The prevalence of depression was 11.8% in our sample. The optimal cut-off point was 11 for the WHO-5 test and 9 for the HSCL-6 test. There were no gender differences. For the WHO-5 and the HSCL-6, respectively, the sensitivity was 0.88 [95% confidence interval (CI): 0.74-0.96] and 0.85 (95% CI: 0.70-0.94), the specificity was 0.80 (95% CI: 0.75-0.85) and 0.79 (95% CI: 0.74-0.84) and the likelihood ratio was 4.5 and 3.8 (P = 0.39). We observed no statistically significant diagnostic differences with respect to nationality or administration procedure. CONCLUSIONS: The WHO-5 and the HSCL-6 may both serve as valid case finding instruments for depression in young people in primary care.

Living with mentally ill parents during adolescence: a risk factor for future welfare dependence? A longitudinal, population-based study.

BACKGROUND: Living with parents suffering from mental illness can influence adolescents' health and well-being, and adverse effects may persist into adulthood. The aim of this study was to investigate the relationship between parents' mental health problems reported by their 15-16-year-old adolescents, the potential protective effect of social support and long-term dependence on public welfare assistance in young adulthood. METHODS: The study linked data from a youth health survey conducted during 1999-2004 among approximately 14 000 15-16-year-olds to data from high-quality, compulsory Norwegian registries that followed each participant through February 2010. Cox regression was used to compute hazard ratios for long-term welfare dependence in young adulthood based on several risk factors in 15-16-year-olds, including their parents' mental health problems. RESULTS: Of the total study population, 10% (1397) reported having parents who suffered from some level of mental health problems during the 12 months prior to the baseline survey; 3% (420) reported that their parents had frequent mental health problems. Adolescent report of their parents' mental health problems was associated with the adolescents' long-term welfare dependence during follow-up, with hazard ratios (HRs) of 1.49 (CI 1.29-1.71), 1.82 (1.44-2.31) and 2.13 (CI 1.59-2.85) for some trouble, moderate trouble and frequent trouble, respectively, compared with report of no trouble with mental health problems. The associations remained significant after adjusting for socio-demographic factors, although additionally correcting for the adolescents' own health status accounted for most of the effect. Perceived support from family, friends, classmates and teachers was analysed separately and each was associated with a lower risk of later welfare dependence. Family and classmate support remained a protective factor for welfare dependence after correcting for all study covariates (HR 0.84, CI 0.78-0.90 and 0.80, 0.75-0.85). We did not find evidence supporting a hypothesized buffering effect of social support. CONCLUSIONS: Exposure to a parent's mental health problem during adolescence may represent a risk for future welfare dependence in young adulthood. Perceived social support, from family and classmates in particular, may be a protective factor against future long-term welfare dependence.

Patients' experience of their general practitioner's follow-up of serious eating disorders.

BACKGROUND: An eating disorder is an illness that may take a life-threatening course. The health authorities recommend that general practitioners (GPs) should be included in the treatment apparatus. The patients' feelings of shame, denial of the illness and ambivalence with regard to treatment are disease-specific characteristics that need to be considered. MATERIAL AND METHOD: At two specialised units for eating disorders, patients aged over 18 were handed a questionnaire at the start of their treatment. The questionnaire dealt with GP consultations in which the eating disorder had been discussed. An active GP-patient relationship was defined based on whether the patient had seen the GP at least three times, whether the GP's office was in proximity to the patient's place of residence and whether the eating disorder had been discussed during the past year. RESULTS: Altogether 114 patients (90%) took part in the study. 66% had an active GP-patient relationship, and 65% of these had discussed with their GP the impact of the disease on their daily lives. Altogether 75% were satisfied with the GP's manner, 47% found the GP to be an important supporter of their treatment and 44% visited their GP if their condition worsened. Those patients who were severely underweight and patients with GPs who demonstrated commitment scored highest on satisfaction and support. A total of 39% of those who had experience of treatment in which their current GP could have been involved in collaboration with the second-line service had found such involvement to be the case. INTERPRETATION: The patients had varying experience of follow-up provided by their GPs. Commitment on the part of the GP appears to result in closer follow-up and greater patient satisfaction.

Communication about symptoms of eating disorders in the general practitioner surgery.

BACKGROUND: An eating disorder is a complex disease in which the patient subjects his or her body to the various eating disorder symptoms in the absence of other ways of dealing with everyday life. There are seven symptoms of an eating disorder that generally appear in different combinations from one period to another in one and the same patient. Feelings of shame may cause information on symptoms to be withheld. MATERIAL AND METHOD: Patients aged 18 and above with serious eating disorders responded anonymously to a questionnaire before entering treatment in two specialist departments. The main focus was on whether the patient had talked with a general practitioner (GP) about relevant eating disorder symptoms and ailments that could be related to the eating disorder. RESULTS: Altogether 114 patients participated (of which three were men). A total of 91 (80%) had discussed the eating disorder with their GP during the past year. Of these, 67% of those who had reduced their food intake over the past year had discussed this with their GP. Altogether 68% of those who had vomited and 33% of those who had over-exercised had communicated this. None of the respondents had revealed their use of diuretic or weight-loss drugs to their GP. 85% of respondents stated that the GP must ask specifically about each symptom of an eating disorder in order to reveal these. At least half had discussed the association between current ailments and the eating disorder. A total of 49% had been weighed. INTERPRETATION: In order to be able to establish the best possible basis for a medical assessment, the GP should ask specifically about each symptom of an eating disorder.

Diagnosis of depressed young people in primary health care--a validation of HSCL-10.

BACKGROUND: According to the World Health Organization, depression ranks as a major contributor to the global burden of disease. A large proportion of adult depressions had their first appearance in adolescence. AIM: Because primary health care professionals lack valid instruments for early identification of depression, we sought to validate HSCL-10. The design of study is a GP multicentre study conducted in Norway and Denmark. The setting of the study is adolescents (14-16 years) responded by answering a questionnaire and later completed a Composite International Diagnostic Interview, which was used as the gold standard. Depression was defined by International Classification of Diseases-10 (ICD-10). Both internal and external validity were examined, the likelihood between pretest and posttest measured and a cut-off point for depression calculated by using the Youden index. RESULTS: The Hopkins Symptom Checklist-10 test (HSCL-10) met the criteria for external and internal validity. When analysed separately, the criteria were met both in Denmark and in Norway and both for paper and web. The optimal cut-off point for the HSCL-10 test was 16 (HSCL-10 = 16/10 items = 1.6), with no gender differences. For girls and boys, respectively, it yielded a sensitivity of 87.5% and 87.5%, specificity of 72.4% and 87.9% and likelihood of 3.2 and 7.2. CONCLUSION: HSCL-10 is a suitable and valid instrument for detecting depression in young people in primary care.

Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office.

BACKGROUND: Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions. AIM: To investigate whether shared care with mental health professionals in GP offices increases the detection of youth's mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician. DESIGN AND SETTING: This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3-8 GP offices. One GP office was randomised to the intervention group and the other to the control group. METHOD: We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth. RESULTS: Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients' regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm. CONCLUSION: Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient's regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group. TRIAL REGISTRATION NUMBER: NCT03624829; Results.

GPs' and child and adolescent psychiatry specialists' experiences of joint consultations in the GP's office: a qualitative study.

BACKGROUND: The study is an exploration of a joint consultation model, a collaboration between general practitioners (GPs) and specialists from child and adolescent mental health services (CAMHS) in Lillehammer, Norway. METHODS: A qualitative study based on two focus group interviews, one with participating GPs and one with participating specialists from the local CAMHS. Participants were five GPs, with work experience varying from 6 months to 20 years (four of them specialists in general medicine) and two CAMHS specialists-a psychiatrist and a psychologist-both with more than 20 years of experience. RESULTS: The focus group discussions revealed that both GPs and CAMHS specialists saw the joint consultations as a good teaching method for improving GPs' skills in child and adolescent psychiatry. Both groups believed that this low-threshold service benefits the patients and that the joint consultation is especially suited to sort problems and determine the level of help required. CONCLUSIONS: The GPs and CAMHS specialists shared the impression that the collaboration model is beneficial for both patients and health care providers. Close collaboration with primary health care is recommended in the guidelines for child and adolescent psychiatry outpatient clinics. We suggest that the joint consultation model could be a good way for GPs and CAMHS specialists to collaborate.

Own and parental war experience as a risk factor for mental health problems among adolescents with an immigrant background: results from a cross sectional study in Oslo, Norway.

BACKGROUND: An increasing proportion of immigrants to Western countries in the past decade are from war affected countries. The aim of this study was to estimate the prevalence of war experience among adolescents and their parents and to investigate possible differences in internalizing and externalizing mental health problems between adolescents exposed and unexposed to own and parental war experience. METHOD: The study is based on a cross-sectional population-based survey of all 10th grade pupils in Oslo for two consecutive years. A total of 1,758 adolescents were included, all with both parents born outside of Norway. Internalizing and externalizing mental health problems were measured by Hopkins Symptom Checklist-10 and subscales of the Strengths and Difficulties Questionnaire, respectively. Own and parental war experience is based on adolescent self-report. RESULTS: The proportion of adolescents with own war experience was 14% with the highest prevalence in immigrants from Eastern Europe and Sub-Saharan Africa. The proportion of parental war experience was 33% with Sub-Saharan Africa being highest. Adolescents reporting own war experience had higher scores for both internalizing and externalizing mental health problems compared to immigrants without war experience, but only externalizing problems reached statistically significant differences. For parental war experience there was a statistically significant relationship between parental war experience and internalizing mental health problems. The association remained significant after adjustment for parental educational level and adolescents' own war experience. CONCLUSION: War exposure is highly prevalent among immigrants living in Oslo, Norway, both among adolescents themselves and their parents. Among immigrants to Norway, parental war experience appears to be stronger associated with mental health problems than adolescents own exposure to war experience.

Identifying depression among adolescents using three key questions: a validation study in primary care.

BACKGROUND: Depression in adolescents is a serious psychiatric illness. GPs play an important role in identifying adolescents with depression and those at risk of developing depression. Few validated tools are suitable for identifying adolescent depression in general practice. AIM: To determine if three verbally asked key questions are valid for identifying depression in adolescents. DESIGN AND SETTING: A cross-sectional, general practice multicentre, validation study was conducted in Oslo, Norway, and Aarhus, Denmark. METHOD: A total of 294 adolescents answered three verbally asked key questions followed by a Composite International Diagnostic Interview (CIDI) for psychiatric diagnosis. Inclusion criteria were age (14-16 years) and fluency in the Norwegian or Danish language. The primary outcome was ROC curve statistics in terms of sensitivity and specificity, predictive values, and likelihood ratios of the three key questions. Secondary outcomes were Loevinger's H, Cronbach's α, and prevalence of depression. RESULTS: The three key questions met the criteria for construct and criterion validity for detecting depression among the adolescents. ROC curve statistics for the three key questions demonstrated an AUC of 0.79 for the answer 'yes' to either screening question and of 0.73 for the answer 'yes' to the help question. The positive predictive value was 31% and the negative predictive value was 97%. CONCLUSION: The three key questions are useful for identifying depression in adolescents in primary health care.

[How to improve continuing education and quality improvement in general practice?]. / Hvordan bedre kvalitet og videre- og etterutdanning i allmennpraksis?

BACKGROUND: Research has shown that many activities routinely used for continuing education and quality improvement in general practice, such as written information and lectures, have little or no effect on practice. MATERIAL AND METHODS: The Norwegian Institute of Public Health initiated a consensus-building process on how to improve continuing education and quality improvement in Norwegian general practice. RESULTS AND INTERPRETATION: The work of the consensus panel led to a report in which nine initiatives were proposed: development of a national plan, strengthening of the support available for group-based learning, academic outreach visits, practice based activities, personal learning plans, a national centre for quality improvement in general practice, improved use of referral and discharge information, multidisciplinary collaboration, and patient involvement.

The impact of conveying the diagnosis when using a biopsychosocial approach: A qualitative study among adolescents and young adults with NES (non-epileptic seizures).

PURPOSE: This qualitative study explored the impact of using a biopsychosocial approach to explain the diagnosis of non-epileptic seizures (NES). METHODS: Semi-structured interviews of eleven adolescents and young adults who had participated in an inpatient follow-up stay of the diagnosis were used. The interviews were taped, transcribed, and analysed using systematic text condensation. RESULTS: Three key themes were identified:1."Threatened self-image": Patients initially perceived their diagnosis as being purely psychological. As they did not accept that they had mental disorders, they interpreted this as frightening and threatening, and resisted the diagnosis.2."Being believed and belief in oneself": Participants had many experiences of being suspected by healthcare providers of staging their seizures. Some had even begun to have doubts themselves as to whether the attacks were voluntary or not. Explaining that unconscious processes are involved in NES contributed towards increasing patients' feelings of being believed, and thereby acceptance of the diagnosis.3."Getting an explanation that makes sense": Some participants identified connections between their personal histories and their seizures and became seizure-free. Others found that the explanatory models gave personal meaning, but did not become seizure-free, while a few continued to doubt whether NES was the correct diagnosis. CONCLUSION: Being believed was the most elemental factor for coping with the condition. Using a biopsychosocial approach to explain the diagnosis may facilitate identification with the explanatory models, and thus acceptance of the diagnosis.

Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial.

OBJECTIVE: To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. DESIGN: Randomised clinical trial with two parallel groups. SETTING: General practices in Oslo and the eastern part of Akershus County. PARTICIPANTS: Patients aged 18-75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. INTERVENTION: The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). MAIN OUTCOME MEASURES: Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. RESULTS: There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). CONCLUSION: Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in hospitals or EMAs. However, the total number of incidents of deliberate self-harm reported by the patients was significantly higher in the intervention group. TRIAL REGISTRATION: Trial registration ClinicalTrials.gov Identifier: NCT01342809.