AP-HP, Cochin Hospital, 97 Boulevard de Port-Royal, Maison de Solenn, 75014, Paris, France.
Sorbonne Université, 75006, Paris, France.
Eur J Pediatr. 2024 Jan;183(1):483-491. doi: 10.1007/s00431-023-05313-5. Epub 2023 Nov 7.
Mental health issues in adolescents with obesity are multifold, with no explicit screening recommendations. The aim of this research is to explore how this screening is performed by physicians and, thus, how it impacts adolescents' care pathways, offering insights into how to improve it through a qualitative study using interpretative phenomenological analysis. Twenty physicians (non-psychiatrist physicians and child and adolescent psychiatrists) involved at various stages in the care pathway were interviewed with semi-structured questionnaires. The findings connect 2 meta-themes. Non-psychiatrist physicians perceive widespread but ill-defined suffering in adolescents with obesity. Non-psychiatrist physicians see screening for mental conditions as mandatory. Unlike child and adolescent psychiatrists, they are not experts in distinguishing psychosocial suffering from psychiatric disorders. Screening is clinical. Adolescents' demand to lose weight in a context of shaming and alexithymia limits their access to psychiatric care. Child and adolescent psychiatrists then redefine the medical response to polymorphous symptoms. Psychiatric diagnoses mainly involve anxiety and depression symptoms, seldom eating disorders. Conclusion: Physicians have overtly conflicting perspectives over the intensity of mental conditions. Non-psychiatrists, sensitive to perceived distress, seek to have it quickly appraised if they detect a significant suffering. Child and adolescent psychiatrists find appraisal complex to perform in the absence of means, interest, and/or experience. Improving screening requires training health professionals and using multidisciplinary assessment means. What is Known: • Mental health and eating disorders are contributing factors of obesity but their relationship remains complex between cause and consequence. • Mental health conditions and psychosocial suffering are the main complications among adolescents suffering from obesity with guilt, sadness, or stigma. What is New: • Non-psychiatric physicians express their need of a specialized diagnosis to define this suffering, but the lack of availability of psychiatrists and the necessity of time and of a multidisciplinary team lead to a delayed assessment. • For psychiatrists, this suffering is often not a psychiatric condition. Though requiring attention, this can lead to a misunderstanding between professionals.
青少年肥胖相关的心理健康问题多种多样，但目前并无明确的筛查推荐。本研究旨在探讨医生如何进行此类筛查，以及这对青少年的治疗路径有何影响，通过使用解释现象学分析的定性研究，深入了解如何改进这一过程。我们对半结构化问卷进行了访谈，共涉及 20 名参与青少年肥胖治疗路径各个阶段的医生，包括非精神科医生和儿童青少年精神科医生。研究结果连接了 2 个元主题。非精神科医生认为肥胖青少年普遍存在但定义不明确的痛苦。非精神科医生认为筛查精神疾病是必要的。与儿童青少年精神科医生不同，他们并非精神障碍与心理社会痛苦之间区别的专家。筛查是临床导向的。在羞辱和述情障碍的背景下，青少年对减肥的需求限制了他们获得精神科护理的机会。然后，儿童青少年精神科医生重新定义了对多态症状的医疗反应。精神科诊断主要涉及焦虑和抑郁症状，很少涉及饮食障碍。结论：医生对精神疾病严重程度的看法明显存在冲突。非精神科医生对感知到的痛苦很敏感，如果发现明显的痛苦，他们会迅速评估。儿童青少年精神科医生发现，如果没有手段、兴趣和/或经验，评估会很复杂。提高筛查需要培训卫生专业人员并使用多学科评估手段。已知内容：·精神健康和饮食障碍是肥胖的促成因素，但它们之间的关系在因果关系上仍然很复杂。·精神健康状况和心理社会痛苦是肥胖青少年的主要并发症，他们感到内疚、悲伤或受到歧视。新内容：·非精神科医生表达了他们对专门诊断的需求，以确定这种痛苦，但精神科医生的缺乏可用性以及时间和多学科团队的必要性导致评估延迟。·对于精神科医生来说，这种痛苦通常不是一种精神疾病。尽管需要关注，但这可能会导致专业人员之间的误解。
