CONFIDENCE OF DOCS ABOUT DIAGNOSING TEEN MENTAL DISORDERS GOOD NOT EXCELLENT Only half screen for mental disorders; Treatment, Resources, and Insurance Coverage Are Barriers to Effective Treatment EMBARGOED UNTIL JANUARY 9, 2004 CONTACT: Dan Romer at 610-202-7315 VISIT: www.appcpenn.org The Annenberg Foundation Trust at Sunnylands will release the findings of a major study of doctors knowledge and treatment of adolescent mental disorders at an international summit at Rancho Mirage, California, January 8-11, 2004. The results will be released at the launch of a national effort to increase the diagnosis and treatment of adolescent mental disorders. The summit will be chaired by University of Pennsylvania Professor Martin Seligman, Ph.D., past president of the American Psychological Association, and Dwight Evans, MD, chair of the department of Psychiatry at the University of Pennsylvania. The summit will bring together seven commissions consisting of 100 of the nation s leading scholars of adolescent mental disorders and their prevention and treatment. (For a list of commission members see http://www.sunnylands.org/amhi/) For the past year and a half each commission has been drafting consensus statements synthesizing what is known about the most prevalent adolescent mental disorders. At the summit, the scholars will finalize these statements on adolescent mood disorders, schizophrenia, anxiety disorders, eating disorders, drug abuse, suicide prevention, and positive interventions. The statements will be published in a book in fall 2004 by Oxford University Press. The Sunnylands Adolescent Mental Health Project will launch a web site for teens in the fall as well. Annenberg Public Policy Center 1
Major mental conditions impair the lives of four million adolescents in the U.S. said Dr. Dwight Evans. Less than half of adolescents with a serious mental disorder receive treatment of any kind and the treatment is often inadequate. This national random sample of 506 doctors who treat adolescents helps explain why. Most doctors are somewhat but not very confident in their diagnostic skills in this area. Only about half of doctors report regularly screening their adolescent patients for mental disorders. The surveyed doctors see insurance coverage and treatment resources in their community as inadequate. DIAGNOSIS: Early identification and treatment can diminish the severity of these illnesses and increase the likelihood that these young people will lead productive lives. When a teen comes in for an annual physical, how likely are doctors to recognize the symptoms of a mental disorder and how comfortable are they in treating depression, bipolar disorder, schizophrenia, anxiety disorders, eating disorders and alcohol and drug abuse in teens? Survey results show that less than half of doctors feel very capable of identifying major mental disorders in their adolescent patients (see Table 1). The highest degree of confidence is for depression (46%). Only about 1 in four (24%) feel very capable of identifying drug abuse. Even fewer are confident about schizophrenia (19%) and bipolar disorder (16%). SCREENING: Half (50%) say they always ask their patients about their mental health during physical exams, while 42% say they ask sometimes. At a more formal level, about half say (51%) they regularly screen their patients for mental disorders during visits. TREATMENT AND INSURANCE: Only about one in three practitioners (31%) say they think that treatment resources are adequate for treating adolescent mental disorders in their community. The majority (58%) strongly feels that lack of adequate insurance coverage hinders the ability of young people to get the treatment they need. Consistent with the lack of confidence in identifying mental disorders, the majority of adolescent primary care physicians describe their knowledge of mental health issues as good but not excellent. Only about 13% describe their knowledge as excellent, while about 55% claim it is good. About a third indicate that their knowledge is only somewhat good or weak. There are no self-described differences in knowledge between younger and older doctors, those in rural, suburban and urban environments and male and female physicians. Annenberg Public Policy Center 2
COMFORT IN TALKING WITH ADOLESCENTS: The good news in the survey is that doctors report that they are comfortable talking with adolescents about mental health and see such talk as part of their job. Three out of four see it as their job to talk to adolescent patients about their mental health. In addition, most (78%) say they feel very comfortable talking about mental health issues with their adolescent patients. National estimates of mental disorders in adolescents vary, and the occurrence of more than one disorder in an individual is common. Depression is clearly the most prevalent with approximately 20% of young people reporting symptoms of the disorder. The lifetime prevalence of the clinical syndrome is about 13% among those under 19 years of age. In addition, approximately 6% of adolescents report an attempt to commit suicide in their lifetimes. Anxiety disorders are also quite prevalent with estimates of about 5% suffering from these symptoms at any time. Substance abuse disorders afflict approximately 2.5% of adolescents. Bipolar disorder, eating disorders, and schizophrenia have lower prevalence of approximately 1% each for the full clinical manifestation. Survey Method. This 25-minute telephone survey was conducted between September and December 2003 with a nationwide, representative sample of 506 primary care physicians by Princeton Survey Research Associates International. The sample was drawn from the AMA Masterlist of physicians to represent pediatricians and family/general practitioners in proportion to their estimated use by adolescents (80% vs. 20%). The margin of error for the survey is +/- 4.4%. Characteristics of the sample are given in Table 2 below. The Annenberg Foundation Trust at Sunnylands exists to advance the well-being of democratic institutions and enhance civic engagement and mental health among the young. Annenberg Public Policy Center 3
Table 1. How capable do you feel you are to identify...in adolescents? Level of Confidence Disorder Very Capable Somewhat Capable Not too Capable Not Capable at All Depression 46 51 2 0 Anxiety disorders, such as panic disorders, social phobias, and obsessive/compulsive disorders 39 55 6 0 Eating disorder 38 56 5 1 Drug abuse 24 67 8 1 Schizophrenia 19 52 24 4 Bipolar disorder 16 60 20 3 Annenberg Public Policy Center 4
Table 2. Characteristics of Sample. Characteristic of Doctor/Practice % Age Under 50 47 50 and older 50 Gender Women 47 Men 53 Region of Country Northeast 33 Midwest 20 South 26 West 22 Urban vs. Rural Urban 44 Suburban 42 Rural 14 Type of Practice Solo 33 Group 57 Hospital 8 Proportion of Patients Insured < 50% 10 51 75% 13 76 100% 75 ### Annenberg Public Policy Center 5