Title: Developing an inclusive approach to multidimensional assessment of mental health symptoms in people in UK primary care
Funder: Department of Health and Social Care

Abstract: Development work questions: How can we creatively engage with community organisations to develop diverse public involvement/engagement for our planned programme? How do we ensure the recruitment of diverse participants into the future proposed programme? How does a diverse sample of participants understand and respond to a multidimensional conceptualisation of common mental health symptoms? Background: The majority of people presenting with mental health problems in the UK are managed by General Practitioners (GPs). Despite the centrality of the identification of disorder in primary care to guide management, this remains a complex and challenging area. The primary problems that stem from this complexity are both over-treatment and under-treatment, which can lead to unnecessary use of medications/exposure to side effects, and conversely, missed cases where opportunities for care and appropriate intervention are lost. In the Netherlands, the use of the Four-Dimensional Symptom Questionnaire (4DSQ) is included in national guidelines to support diagnostic conversations in primary care. The 4DSQ is unique in providing a broad symptom profile including distress, depression, anxiety and physical symptoms. The separation of distress from depression and anxiety may support distinctions between stress-related symptoms and psychopathology. Aims and objectives: Currently, the 4DSQ is not used in the UK. We aim to determine whether using the 4DSQ in UK primary care is acceptable to patients and clinicians, and whether it can improve mental health outcomes, through targeting and personalisation of care. Objective of development work: To ensure a future programme on the 4DSQ is inclusive of diverse patient groups, and consequently, our findings applicable across a diverse range of the UK population. Development work plan: We plan four concurrent workstreams. WS1: We will continue to build our team through monthly development and planning meetings. WS2: Working with community centres in three diverse districts of Southampton, as well a charity working with disadvantaged older adults in North Staffordshire, we will build relationships, seek feedback and develop mechanisms for ongoing public input into the programme. WS3: We update current reviews on recruiting diverse samples using a rapid approach and tabulate findings, then combine this work with public input to develop recruitment approaches for the main programme. WS4: We will conduct a qualitative study to explore how a diverse sample of people understand and interpret 4DSQ score profiles. Timelines for delivery: Monthly planning meetings (WS1) will be used to build the team and guide the workstreams. Public outreach work (WS2) will continue over the 12 months of the project. Developing inclusive recruitment strategies (WS3) will be conducted in the first 3 months of the project. The qualitative study (WS4) will run concurrently across the 12 months. Anticipated impact and dissemination: Use of the 4DSQ in UK practice has the potential to directly benefit patients, through improved targeting and personalisation of mental health care in general practice. The proposed development workstreams will ensure inclusion and diversity are central in this 4DSQ research from the outset. Findings from the development work will be disseminated via publications, social media, public and professional networks and directly to participants.

Lay abstract: Aim: We aim to ensure research looking into a novel approach to assessing and managing mental health symptoms is developed with, and includes, a diverse range of people. Background: General Practitioners (GPs) care for the majority of people who approach health care services for support with mental health issue. Part of their role is to decide when symptoms reflect issues like depression and anxiety, and when they may not. They will suggest treatment and offer ideas about symptoms on this basis. However, deciding on diagnosis and treatment can be complicated, particularly when patients face stressful life circumstances. Some people suggest that GPs provide treatment (such as antidepressants) that are unnecessary, whilst others worry that GPs miss people experiencing a problem like depression which then goes un-treated. Dutch GPs often use a specific questionnaire that can help to distinguish distress/stress from depression and anxiety. This is not currently used in the UK. In a future programme of research we will evaluate whether this questionnaire is helpful, and reduces patients' symptoms, compared to current usual care. Development work plan: In order to ensure the work we suggest on this questionnaire does not miss out diverse groups, including people from ethnic minority communities and/or from areas with greater social deprivation, we plan a number of workstreams. In the first workstream we will ensure our team has all the expertise needed, and we will recruit further public contributors to the team. In the second workstream, we will work with community groups and charities to develop ways to connect with people from different backgrounds to help us design our research. The third workstream will continue this work; learning from previous studies about ways to achieve inclusive recruitment and talking this through with people from community groups and our PPIE representatives. In the fourth workstream we will interview people who have experienced mental health symptoms to explore how they find using the new questionnaire, and how they feel about their scores on the different questionnaire items. Patient and public involvement: Patient and public involvement forms a central part of this application. We will have a PPI coordinator to support our PPI activities, a PPI co-applicant and further public contributors as part of our stakeholder group. We also have a full workstream focusing on community engagement. Outcomes and dissemination: The new approach including use of this questionnaire may directly benefit patients by supporting GPs to provide more appropriate care for mental health symptoms. Through our planned work we will ensure as many people as possible with different backgrounds are included in developing, participating in, and receiving the benefits from future research. We will share our research via social media, journals and feedback to community groups and participants.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH