Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study

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Abstract

Background

In Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents.

Methods

A prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models.

Results

Cross-sectional ( n = 1090) and longitudinal analyses ( n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020).

Conclusion

This evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01780-1.

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Most cited references 34

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Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies

Peter C Austin, Elizabeth A. Stuart (2015)

The propensity score is defined as a subject's probability of treatment selection, conditional on observed baseline covariates. Weighting subjects by the inverse probability of treatment received creates a synthetic sample in which treatment assignment is independent of measured baseline covariates. Inverse probability of treatment weighting (IPTW) using the propensity score allows one to obtain unbiased estimates of average treatment effects. However, these estimates are only valid if there are no residual systematic differences in observed baseline characteristics between treated and control subjects in the sample weighted by the estimated inverse probability of treatment. We report on a systematic literature review, in which we found that the use of IPTW has increased rapidly in recent years, but that in the most recent year, a majority of studies did not formally examine whether weighting balanced measured covariates between treatment groups. We then proceed to describe a suite of quantitative and qualitative methods that allow one to assess whether measured baseline covariates are balanced between treatment groups in the weighted sample. The quantitative methods use the weighted standardized difference to compare means, prevalences, higher‐order moments, and interactions. The qualitative methods employ graphical methods to compare the distribution of continuous baseline covariates between treated and control subjects in the weighted sample. Finally, we illustrate the application of these methods in an empirical case study. We propose a formal set of balance diagnostics that contribute towards an evolving concept of ‘best practice’ when using IPTW to estimate causal treatment effects using observational data. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

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Psychometric properties of the strengths and difficulties questionnaire.

ROBERT GOODMAN (2001)

To describe the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a brief measure of the prosocial behavior and psychopathology of 3-16-year-olds that can be completed by parents, teachers, or youths. A nationwide epidemiological sample of 10,438 British 5-15-year-olds obtained SDQs from 96% of parents, 70% of teachers, and 91% of 11-15-year-olds. Blind to the SDQ findings, all subjects were also assigned DSM-IVdiagnoses based on a clinical review of detailed interview measures. The predicted five-factor structure (emotional, conduct, hyperactivity-inattention, peer, prosocial) was confirmed. Internalizing and externalizing scales were relatively "uncontaminated" by one another. Reliability was generally satisfactory, whether judged by internal consistency (mean Cronbach a: .73), cross-informant correlation (mean: 0.34), or retest stability after 4 to 6 months (mean: 0.62). SDQ scores above the 90th percentile predicted a substantially raised probability of independently diagnosed psychiatric disorders (mean odds ratio: 15.7 for parent scales, 15.2 for teacher scales, 6.2 for youth scales). The reliability and validity of the SDQ make it a useful brief measure of the adjustment and psychopathology of children and adolescents.

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The Strengths and Difficulties Questionnaire: a research note.

R. Goodman (1997)

A novel behavioural screening questionnaire, the Strengths and Difficulties Questionnaire (SDQ), was administered along with Rutter questionnaires to parents and teachers of 403 children drawn from dental and psychiatric clinics. Scores derived from the SDQ and Rutter questionnaires were highly correlated; parent-teacher correlations for the two sets of measures were comparable or favoured the SDQ. The two sets of measures did not differ in their ability to discriminate between psychiatric and dental clinic attenders. These preliminary findings suggest that the SDQ functions as well as the Rutter questionnaires while offering the following additional advantages: a focus on strengths as well as difficulties; better coverage of inattention, peer relationships, and prosocial behaviour; a shorter format; and a single form suitable for both parents and teachers, perhaps thereby increasing parent-teacher correlations.

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Author and article information

Contributors

Siona Decke: siona.decke@med.uni-muenchen.de

Journal

Journal ID (nlm-ta): BMC Prim Care

Journal ID (iso-abbrev): BMC Prim Care

Title: BMC Primary Care

Publisher: BioMed Central (London )

ISSN (Electronic): 2731-4553

Publication date (Electronic): 22 August 2022

Publication date PMC-release: 22 August 2022

Publication date Collection: 2022

Volume: 23

Electronic Location Identifier: 211

Affiliations

[1 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, , LMU Munich, ; Munich, Germany

[2 ]Pettenkofer School of Public Health, Munich, Germany

[3 ]BKK Vertragsarbeitsgemeinschaft Bayern, Munich, Germany

[4 ]Berufsverband der Kinder- und Jugendärzte (BVKJ) e.V., Cologne, Germany

[5 ]PaedNetz Bayern e.V., Munich, Germany

[6 ]GRID grid.4567.0, ISNI 0000 0004 0483 2525, Institute of Health Economics and Health Care Management (IGM), , Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), ; Neuherberg, Germany

[7 ]GRID grid.9018.0, ISNI 0000 0001 0679 2801, Department of Economics, , Martin Luther University Halle-Wittenberg, ; Halle (Saale), Germany

[8 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, German Centre for Vertigo and Balance Disorders, , University Hospital, LMU Munich, ; Munich, Germany

Article

Publisher ID: 1780

DOI: 10.1186/s12875-022-01780-1

PMC ID: 9396915

PubMed ID: 35996092

SO-VID: 91f245a0-d85d-421f-8c5b-9a552f6f1c65

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 September 2021

Date accepted : 21 June 2022

Funding

Funded by: German Innovationsfonds

Award ID: 01VSF16032

Award Recipient : Siona Decke Karina Hamacher Martin Lang Otto Laub Lars Schwettmann Eva Grill

Funded by: Ludwig-Maximilians-Universität München (1024)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

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Keywords: mental health problems,children and adolescents,paediatrician,health coaching programme,cohort study

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Keywords: mental health problems, children and adolescents, paediatrician, health coaching programme, cohort study

Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study

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Chinese Journal of School Health

Most cited references 34

Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies

Psychometric properties of the strengths and difficulties questionnaire.

The Strengths and Difficulties Questionnaire: a research note.

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