Visitation and stratification of help-seeking youth with mental health problems: a three-year follow-up study

Stage-based stepped care approaches aim to address gaps between prevention and specialized treatment for mental disorders by directing proportionate interventions in a timely manner. We examined whether increasing stage level, assigned after visitation of youths seeking help in a primary care municipal setting, reflected an increased risk of adverse outcomes after three years.

Help-seeking youths (6-16 years) were stratified into three stages of developmental psychopathology based on the severity and impact of parent- and self-reported mental health problems corresponding to following levels of need for actions: low-intensity intervention (Stage 1); moderate-intensity preventive intervention, (Stage 2); suggested referral to specialized mental health services (Stage 3). Information on diagnosed mental disorders and prescription of psychotropic medications over the following 3.6 years (median follow-up) was retrieved from the Danish National Registries. Outcomes were compared across the staged groups and compared to an age-matched population-based comparison group (N = 16,980, reference group).

Among 566 help-seeking youths, n = 74 (13%) were stratified to Stage 1, n = 436 (77%) to Stage 2, and n = 56 (10%) to Stage 3. Hazard ratios (95% confidence intervals) of receiving a psychiatric diagnosis during three years of follow-up were 3.2 (1.9-5.2) for Stage 1, 3.9 (3.2-4.8) for Stage 2, and 9.0 (6.2-13.3) for Stage 3. Similar stepwise increasing estimates were present regarding use of psychotropic medications, school absence and notifications of concern.

Increased risk of later psychiatric morbidity with increased stage level supports the clinical utility of the stage-based stratification-model for early detection and treatment in the primary care sector.