The patient journeys of children and adolescents with depression: a study of electronic health records

Author:

Wickersham AliceORCID,Westbrook JulietteORCID,Colling Craig,Downs JohnnyORCID,Govind RishaORCID,Kornblum Daisy,Lewis Jonathan,Smith PatrickORCID,Ford TamsinORCID

Abstract

AbstractIn England, children and adolescents with depression can seek treatment from specialist mental health services. We know little about how they journey through these services, or whether healthcare providers collect sufficient data to accurately appraise this. We aimed to summarise the child and adolescent depression pathway for two healthcare providers. This cohort study used de-identified electronic health records extracted from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) and South London and Maudsley NHS Foundation Trust (SLaM). We identified referrals between 2015 and 2019 during which the referred patient received their first depression diagnosis aged < 18 years. We described patient demographic and clinical characteristics, and features of the referral. In total, n = 296 (CPFT) and n = 2502 (SLaM) patients had a referral which met eligibility criteria. In both sites, patients were more frequently female (CPFT 79.3%; SLaM 69.3%) and White ethnicity (CPFT 88.9%; SLaM 57.9%) as compared to respective population estimates for the Trusts’ catchment areas. Patients typically received their first depression diagnosis during adolescence (median ages 16 in CPFT and 15 in SLaM). The most common comorbidity was anxiety disorder. Referrals were usually routine, to community teams specialising in the child age group. Commonly mentioned interventions included antidepressant medication, cognitive behavioural therapy, and dialectical behaviour therapy. However, pathways varied within and between sites, and the quality and consistency of some data was poor. These findings provide an overview of service pathways experienced by children and adolescents with depression, but also highlight that pathways can vary according to individual need and healthcare provider. More systematic collection of some data, and standardisation in record systems used by different providers, would be beneficial.

Funder

NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London

Publisher

Springer Science and Business Media LLC

Subject

Psychiatry and Mental health,Developmental and Educational Psychology,General Medicine,Pediatrics, Perinatology and Child Health

Reference19 articles.

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5. National Institute for Health and Care Excellence (NICE) (2019) Depression in children and young people: identification and management. https://www.nice.org.uk/guidance/ng134 Access 14 Oct 2021

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