Lack of mental well-being in 15-year-olds: an undisclosed iceberg?

Background. Young people suffer from psychiatric symptoms and illness, and the frequency of both may be higher than currently is recognized. The frequ ency with which young people consult GPs with emotional problems is not est ablished. Objective. The purpose of this study was to identify the number of 15-year- olds who consult their GP directly or indirectly with psychiatric symptoms or illness. Methods. A two part survey was carried out involving (i) general practice c asenote review; and (ii) questionnaires self-report. The subjects comprised all adolescents aged 15 years from 34 randomly selected general practices and a randomly selected subsample of these adolescents. The main outcome me asures were a purpose-designed data collection sheet, General Health Questi onnaire (GHQ-12) and a purpose-designed self-report questionnaire. Results. In phase 1, the general practice casenotes of 2359 adolescents wer e examined. Five per cent of subjects were identified as attending the GP w ith mental health problems; 1% had attempted suicide during the year. In ph ase 2, 99 subjects returned completed self-report questionnaires. Although over a quarter (26%) were rated as GHQ-12 'cases' and approximately half re ported having felt 'sad, unhappy or low' or 'anxious or worried' in the pre vious year, on ly one subject reported attending his/her GP with any of the se concerns. Conclusions. Fifteen-year-olds rarely consult their GP about their emotiona l well-being, yet, with the GHQ-12, the self-reported rate of psychiatric m orbidity was nearly seven times greater than that suggested by these same s ubjects' medical records. Although the majority of adolescents consult thei r GP throughout the course of a year, those with mental health problems, in cluding those who attempt suicide, are indistinguishable in the frequency o f their GP consultations from adolescents without mental health problems.