Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.
Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.
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DOI：
10.1186/s12875-016-0504-1
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发表时间：
2016-08-04
影响因子：
2.9
通讯作者：
Sanci LA
中科院分区：
文献类型：
--
作者：
Webb MJ;Kauer SD;Ozer EM;Haller DM;Sanci LA
青春期和青年期是重要的发育时期。在常规初级保健访问期间筛查危害健康的行为和精神健康障碍，有可能帮助临床医生确定令人关切的领域并提供适当的干预措施。本系统综述的目的是调查初级保健机构对多种危害健康行为和精神健康障碍的筛查和随后的干预措施是否能改善年轻人的健康结果。使用系统评价和荟萃分析首选报告项目（PRISMA）指南，在Medline、PsycINFO、Scopus和Cochrane图书馆数据库（Prospero注册号CRD42013005828）中进行文献检索，检索词代表四个主题概念：初级保健、年轻人、筛查、心理健康和健康危害行为。为了符合纳入条件，研究必须：包括对健康结果的测量；至少75%的参与者年龄在25岁以下；使用可评估一个以上健康领域的筛选工具；并在初级保健环境中进行。使用质量评定量表评估偏倚风险。从5051篇文章中，9项研究符合纳入标准，并进行了回顾：2项随机对照试验（RCT）， 1项先导RCT， 2项聚类RCT， 1项随机研究，多干预组，无对照组，1项聚类RCT， 2个活动臂，1项纵向研究和1项前后研究。包括两项随机对照试验和一项聚类随机对照试验在内的七项研究发现，物质使用、饮食、性健康或危险的性行为、与酒精有关的危险行为、社会压力、压力管理、头盔使用、睡眠和锻炼等方面发生了积极变化。只有两项研究报告了危害，其中一项报告了饮酒增加对健康的负面影响。有一些证据表明，在临床环境中对年轻人进行心理健康障碍或危害健康行为的筛查和干预可以改善健康结果。除了其他证据表明年轻人重视与提供者讨论健康风险外，这些讨论应成为年轻人常规初级保健的一部分。需要进一步的高质量研究来加强这一证据。本文的在线版本（doi:10.1186/s12875-016-0504-1）包含补充材料，仅供授权用户使用。
Adolescence and young adulthood are important developmental periods. Screening for health compromising behaviours and mental health disorders during routine primary care visits has the potential to assist clinicians to identify areas of concern and provide appropriate interventions. The objective of this systematic review is to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in Medline, PsycINFO, Scopus and Cochrane Library databases (Prospero registration number CRD42013005828) using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour. To be eligible for inclusion, studies had to: include a measure of health outcome; include at least 75 % of participants aged under 25 years; use a screening tool that assessed more than one health domain; and be conducted within a primary care setting. Risk of bias was assessed using the Quality Rating Scale. From 5051 articles identified, nine studies fulfilled the inclusion criteria and were reviewed: two randomised controlled trials (RCTs), one pilot RCT, two clustered RCTs, one randomised study with multiple intervention groups and no control group, one cluster RCT with two active arms, one longitudinal study and one pre-post study. Seven studies, including two RCTs and one clustered RCT, found positive changes in substance use, diet, sexual health or risky sexual behaviour, alcohol-related risky behaviour, social stress, stress management, helmet use, sleep and exercise. Of only two studies reporting on harms, one reported a negative health outcome of increased alcohol use. There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Along with other evidence that young people value discussions of health risks with their providers, these discussions should be part of the routine primary care of young people. Further quality studies are needed to strengthen this evidence. The online version of this article (doi:10.1186/s12875-016-0504-1) contains supplementary material, which is available to authorized users.