Informative value of referral letters from general practice for child and adolescent mental healthcare

• Published in: European child & adolescent psychiatry Vol. 32; no. 2; pp. 303 - 315
• Main Authors: Aydin, S., Crone, M. R., Siebelink, B. M., Numans, M. E., Vermeiren, R. R. J. M., Westenberg, P. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2023; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Age; Age differences; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention deficit hyperactivity disorder; Chart reviews; Child; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Classification; Eating disorders; Family physicians; General Practice; Health care; Humans; Medical diagnosis; Medical records; Medical referrals; Medicine; Medicine & Public Health; Mental Health Services; Original Contribution; Patients; Psychiatry; Referral and Consultation; Reproducibility; Statistical analysis; Teenagers; Psychiatry general practice; Child and adolescent mental healthcare; Diagnostic agreement; Referral letter
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-021-01859-7

Although referral letters (RLs) form a nodal point in a patient’s care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice ( N  = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9–70.6 for anxiety disorders to 90.5–100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03–1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners’ RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.