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31-08-2011 | Psychology | Article

Missed doctor appointments by young adults may signal mental health problems


Free abstract

MedWire News: Skipping primary care appointments may indicate mental health problems in young adults, recent findings suggest.

In general, young adults are the least likely to attend primary care appointments. The most common explanations given by all non-attenders are related to time management, but there may be other reasons that the non-attender is reluctant to admit. Andrew Moscrop (University of Oxford, UK) and colleagues explored the meaning behind non-attendance by young adults and what may be possible causes.

The investigators identified 209 people, aged 15 to 35 years, who were registered to a single practice in a low-income neighborhood and had failed to keep an appointment during 2008. Patient records were evaluated to see if they had kept another appointment within 2 weeks of their non-attendance, made another appointment but not attended, or visited an emergency department or after-hours clinic.

An age- and gender-matched cohort (n=418) was assembled from patients who had never missed an appointment. Records of both groups were reviewed for reports of alcohol abuse, opioid drug use or maintenance therapy, mental health problems, and prescriptions of psychiatric medications.

As the investigators expected, non-attendance was more frequent in patients using heroin or taking methadone and was correlated with living in a socioeconomically depressed area. Non-attenders were more likely to have been diagnosed with mental health problems or symptoms in the past (31.0% vs 8.9%) and been prescribed a psychiatric medication (12.3% vs 2.4%, primarily antidepressants), as reported in the journal Family Practice.

Missing an appointment was associated with a greater likelihood of presenting with mental health problems at any time within 1 year of the original appointment (32.0% vs 7.4% of controls). In that timeframe, the non-attender group also had a higher rate of referrals to mental health services and greater chance of being diagnosed with a mental health problem for the first time.

The investigators note that the their study was restricted to one clinic in one city, with a population demographic representative of that area. It also does not give further explanations as to why people fail to show for appointments or inform office staff in advance that they're cancelling. Nevertheless, they state that the key takeaway for clinicians is that "when a young adult fails to attend a GP appointment, it is a strong predictor of a potential mental health problem. The general practice may be considered to have a responsibility to follow this up and, if appropriate, offer a further appointment."

By Stephanie Leveene

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