Background
Health compromising behaviours and mental health in adolescence
Opportunities for detecting health compromising behaviours and mental health disorders in primary care
Barriers to screening for and intervening with health compromising behaviours and mental health disorders in primary care
Available tools for screening for health compromising behaviours and mental health disorders and useful interventions
Evidence for benefits of screening and intervening for multiple and commonly co-occurring health compromising behaviours and mental health disorders
Methods
Study | Screening tool | Sample/study design, setting | Intervention and outcomes measured | Findings | QRSa |
---|---|---|---|---|---|
Chen et al. (2011) [45] | Face-to-face (trained researchers with computer-assisted personal interviewing technology), private room within clinical setting, eligibility screen Domains screened: • substance use • sexual risk • medication adherence | N = 142, 16–24 years, primary care clinic for HIV positive young people, 5 sites, 45 % female, HIV positive with at least 2 of 3 HIV risk behaviours, RCT | 4 × 60 minute motivational interviewing (MI) sessions focused on 2 most problematic behaviours by mental health clinicians Outcomes measured: • no condom use behaviour • risk of no condom use behaviour | Improvement: • no condom use for participants categorised as at increased sexual risk (adjusted B = .364, p < .01) and those categorised as not at risk (adjusted B = .325, p < .01) • low sexual risk (63 % vs. 32 %, p < .01) and likelihood to be in delayed high sexual risk group (16 % v 50 %, p < .01) | 35.5 |
Mason et al. (2011) [46] | Face-to-face (trained interviewer), clinic waiting room, eligibility screen Domains screened: • substance use (incl. drink driving) • mental health | N = 28, 14–18 years, general primary care, 1 site, 100 % female, African American with at least 1 substance use risk, pilot RCT. | 1 × 20 min MI session with a social network component by trained interviewers (not clinical staff) Outcomes measured: • substance use • trouble due to alcohol • substance use before sex • social network quality • offers to use marijuana • social stress • readiness to start counselling | Improvement: • substance use before sex (F(1) = 4.870, p = .038, η2 = 0.18) • social stress (F(1) = −0.187,p = .047, η2 = 0.16), • trouble due to alcohol use (F(1) = 4.301, p = .049, η2 = 0.15) • offers to use marijuana (F(1) = 4.222, p = .047, η2 = 0.14) No change: • substance use • social network quality • readiness to start counselling | 22 |
Olson et al. (2008) [52] | Digital (PDA) self-administrated, waiting room, intervention screen Domains screened: • diet • exercise • screen time • substance use | 11–20 years, general primary care, two cross-sectional sample recruited pre and post intervention within 5 sites and completed baseline and 6 month follow up survey. Usual care group prior to intervention: N = 148, 47 % female Participants recruited 1 year after intervention introduced in practices: N = 136, 50 % female | 1 × brief MI session by trained clinician within consultation. Outcomes measured: • exercise • fruits and vegetables • milk intake • sweetened beverages • screen time | Improvement: • exercise scores between intervention (0.581) and control (−0.220, p = .006) • milk intake between intervention (0.190) and usual care (−0.313, p = .012)b No change: • fruit and vegetables • sweetened beverages • screen time | 23.5 |
Ozer et al. (2011) [51] | Pen/paper, self-administrated, waiting room, intervention screen Domains screened: • seat belt and helmet use • substance use • sexual behaviour | 14 years, paediatric clinic Longitudinal study (N = 904) compared with several cross-sectional surveys (safety N = 579, sexual behaviour N = 1306, substance use N = 1410) | 2 × clinical encounters: 1. provider intervention following ‘5 A’ framework for behavioural counselling; 2. health educator intervention 15–30 min informed by social cognitive theory Outcomes measured: • seat belt use • helmet use • tobacco use • alcohol use • drug use • sexual behaviour | Improvement: • helmet use (OR = 2.0, 95 %, CI = 1.1,3.7, p ≤ .05). No change: • smoking • alcohol • drug use • sexual behaviour | 28 |
Patrick et al. (2006) [44] | Computer, self-administrated, immediately before intervention in the clinical office, intervention screen Domains screened: • diet • exercise | N = 819, 11–15 years, general primary care, 6 sites, stratified by gender (53 % female), RCT with sun exposure protection as control group. Participants booked in for a well care visit | A 12-month intervention consisting of a computer-assisted stage of readiness-based goal setting followed by brief health care provider counselling, a printed manual and 12 months of monthly mail and telephone counselling, parent intervention to help encourage change in diet and physical activity Outcomes measured: • calories from fat • fruit and vegetable servings • sedentary behaviour • minutes per week exercise • days per week exercise | Improvement: • sedentary behaviours per week for girls (% change was −12 % for intervention and 4.8 % for control group, p = .001) and boys (% change was −24 % for intervention and 2.4 % for control group, p = .001) • physical active days per week for boys (relative risk,1.47, 95 % CI: 1.19,1.75) compared to the control group No change: • calories from fat • fruit/vegetables • minutes of physical activity per week | 34 |
Sanci et al. (2015) [48] | Practitioner (in consultation)- or self-administrated (waiting room), pen/paper, intervention screen Domains screened: • diet • exercise • substance use • mental health • violence and safety (incl. drink driving) | N = 901, 14–25 years, general primary care, 40 sites, 76 % female, pragmatic clustered RCT stratified by postcode advantage score and billing type | Intervention: Clinician training (9 h) in health risk screening, motivational interviewing, youth friendly practice; 2 × clinic visits. Comparison: Didactic educational seminar in youth and health risk screening Outcomes measured: • tobacco use • alcohol use • illicit drug use • risk of STI • risk of unplanned pregnancy • road safety • emotional distress | Improvement: • illicit drug use at 3 months (RD −6.0, CI:-11,−1.2; OR 0.52, CI: 0.28, 0.96) • risk for STI at 3 months (RD −5.4, CI: −11, 0.2; OR 0.66, CI: 0.46,0.96) • unplanned pregnancy at 12 months (RD −4.4; CI: −8.7, −0.1; OR 0.40, CI: 0.20,0.80) No change: • tobacco use • alcohol use • road safety • emotional distress | 40 |
Stevens et al. (2002) [50] | Self-administrated pen/paper, subject home, intervention screen (in both intervention arms) Domains screened: • substance use • seat belt and helmet use • gun access and use | N = 3525c, paediatric clinic, 12 sites, 46 % female, 5th and 6th grade adolescents and parents, clustered RCT with two active arms | 1 of 2 interventions: 1. home interventions (parent discussed risk with child and developed plan) plus practice intervention included MI. 2. site visits, newsletters, telephone calls; printed material Outcomes measured: • alcohol use • tobacco use • seatbelt use • helmet use • gun storage | No change: • tobacco use • seatbelt use • gun storage Negative effect: • Increased alcohol use at 24 and 36 months; OR = 1.27, 95 % CI: 1.03, 1.55, p = .02 and OR: 1.30, 95 % CI: 1.07, 1.57, p = .01, respectively | 29.5 |
Walker et al. (2002) [47] | Face-to-face (nurse), unspecified location, intervention screen Domains screened: • mental health • physical health • substance use • diet • exercise • sexual health knowledge • health damaging behaviours | N = 1516, 14–16 years, general primary care, 8 sites, 51 % female, clustered RCT | 1 × 20 min consultation with nurse to discuss health concerns & develop plans for healthier lifestyles based on self-efficacy and behaviour change Outcomes measured: • diet • exercise • tobacco use • alcohol use | No Change: • smoking • alcohol use • exercise • diet | 26.5 |
Werch et al. (2007) [49] | Computer, self-administrate, immediately before intervention in quiet clinic office, intervention screen (in all 3 intervention arms) Domains screened: • exercise • diet • sleep • stress management • substance use | N = 155c, student health care, 1 site, 66 % female, 3 arms randomised trial | 1 of 3 interventions from trained research staff: 1. multiple behaviour health contract based on Behavior-Image Model; 2. 1 × 25 min tailored consultation with fitness specialist; or 3. a combined consultation plus contract intervention Outcomes measured: • alcohol use • tobacco use • marijuana use • drink driving • exercise • diet • sleep • quality of life • self-control • stress management | Improvement: • drink driving behaviours in all groups (F(2136) = 4.43, p = .01) • exercise behaviours in all groups, (F(5140) = 6.12, p < .001) • nutrition habits in all groups, (F(3143) = 5.37, p < .001) • sleep habits in all groups (F(2144) = 5.03, p = .01), and health quality of life, (F(5140) = 3.09, p = .01) • Stress management F(2144) = 5.48, p = .01, and the number of health behaviour goals set in the last 30 days, F(2143) = 5.35, p = .01, but only among adolescents receiving the consultation, or consultation plus contract No change: • alcohol use • tobacco use • marijuana use • quality of life • self-control | 25.5 |