Little information is available on the clinical trajectories of children and adolescents who attend general practice (GP) with psychiatric symptoms. We aimed to examine 5-year service use in English primary care for children and adolescents with neurodevelopmental or mental health symptoms or diagnoses. In this retrospective cohort study, we used anonymised primary care health records from the Clinical Practice Research Datalink Aurum database (CPRD-Aurum). We identified children and adolescents (aged 3–18 years) presenting to primary care in England between Jan 1, 2000, and May 9, 2016, with a symptom or diagnosis of a mental health, behavioural, or neurodevelopmental condition. Participants were excluded if they had less than 1 year of follow-up. We followed up participants from their index date until either death, transfer out of the practice, or the end of data collection on May 5, 2021, and for trajectory analysis we limited follow-up to 5 years. We used group-based multi-trajectory models to identify clusters with similar trajectories over 5 years of follow-up for three primary outcomes: mental health-related GP contacts, psychotropic medication prescriptions, and specialist mental health-care contact. We did survival analysis to examine the associations between trajectory-group membership and hospital admission for self-harm or death by suicide, as indicators of severe psychiatric distress. We included 369 340 children and adolescents, of whom 180 863 (49·0%) were girls, 188 438 (51·0%) were boys, 39 (<0·1%) were of indeterminate gender, 290 125 (78·6%) were White, 9161 (2·5%) were South Asian, 10 418 (2·8%) were Black, 8115 (2·2%) were of mixed ethnicity, and 8587 (2·3%) were other ethnicities, and the median age at index presentation was 13·6 years (IQR 8·4–16·7). In the best-fitting, seven-group, group-based multi-trajectory model, over a 5-year period, the largest group (low contact; 207 985 [51·2%]) had low rates of additional service contact or psychotropic prescriptions. The other trajectory groups were moderate, non-pharmacological contact (43 836 [13·0%]); declining contact (25 469 [8·7%]); year-4 escalating contact (18 277 [6·9%]); year-5 escalating contact (18 139; 5·2%); prolonged GP contact (32 147 [8·6%]); and prolonged specialist contact (23 487 [6·5%]). Non-White ethnicity and presentation in earlier study years (eg, 2000–2004) were associated with low-contact group membership. The prolonged specialist-contact group had the highest risk of hospital admission for self-harm (hazard ratio low-contact group 2·19 [95% CI 2·03–2·36]) and suicide (2·67 [1·72–4·14]). Most children and adolescents presenting to primary care with psychiatric symptoms or diagnoses have low or declining rates of ongoing contact. If these trajectories reflect symptomatic improvement, these findings provide reassurance for children and adolescents and their caregivers. However, these trajectories might reflect an unmet need for some children and adolescents. National Institute for Health and Care Research and the Wellcome Trust.

中文翻译：

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英国全科医生出现精神症状的儿童和青少年的 5 年心理健康结果：一项回顾性队列研究

关于患有精神症状就读全科医生 (GP) 的儿童和青少年的临床轨迹的信息很少。我们的目的是调查英国初级保健中针对患有神经发育或心理健康症状或诊断的儿童和青少年的 5 年服务使用情况。在这项回顾性队列研究中，我们使用了临床实践研究数据链 Aurum 数据库 (CPRD-Aurum) 中的匿名初级保健健康记录。我们确定了 2000 年 1 月 1 日至 2016 年 5 月 9 日期间在英格兰就诊的儿童和青少年（3-18 岁），其症状或诊断为心理健康、行为或神经发育状况。如果参与者的随访时间少于一年，则被排除在外。我们从参与者的指数日期开始对其进行随访，直至死亡、转出诊所或 2021 年 5 月 5 日数据收集结束，对于轨迹分析，我们将随访时间限制为 5 年。我们使用基于群体的多轨迹模型来识别在 5 年随访中针对三个主要结果具有相似轨迹的聚类：与心理健康相关的全科医生接触、精神药物处方和专业心理保健接触。我们进行了生存分析，以检查轨迹组成员身份与因自残或自杀死亡入院之间的关联，作为严重精神困扰的指标。我们纳入了 369 340 名儿童和青少年，其中 180 863 名 (49·0%) 为女孩，188 438 名 (51·0%) 为男孩，39 名 (<0·1%) 性别不确定，290 125 名 (78·0%) 为性别不定者。 6%）为白人，9161 人（2·5%）为南亚人，10 418 人（2·8%）为黑人，8115 人（2·2%）为混血儿，8587 人（2·3%）为其他族裔种族，指数呈现时的中位年龄为 13·6 岁（IQR 8·4–16·7）。在最适合的、七组、基于组的多轨迹模型中，在 5 年期间，最大的组（低接触；207 985 [51·2%]）的额外服务接触或精神药物的比率较低处方。其他轨迹组为中度、非药物接触 (43 836 [13·0%])；减少联系（25 469 [8·7%]）；第四年升级接触（18 277 [6·9%]）；第 5 年升级接触（18 139；5·2%）；长时间接触全科医生（32 147 [8·6%]）；以及长期的专家接触（23 487 [6·5%]）。早期研究年份（例如 2000-2004 年）的非白人种族和表现与低接触群体成员资格相关。长期专家接触组因自残（风险比低接触组 2·19 [95% CI 2·03–2·36]）和自杀入院的风险最高（2·67 [1·72]） –4·14]）。大多数因精神症状或诊断而到初级保健机构就诊的儿童和青少年的持续接触率较低或正在下降。如果这些轨迹反映了症状的改善，那么这些发现就可以为儿童和青少年及其照顾者提供保证。然而，这些轨迹可能反映出一些儿童和青少年的需求未得到满足。国家健康与护理研究所和威康信托基金会。