Mental distress or psychiatric condition? Exploring the gray area of categorizing psychological suffering among adolescents with obesity: a mixed methods study.

Introduction Obesity in adolescents is associated with increased mental distress and psychiatric disorders, both of which are under-diagnosed in clinical practice. Methods We designed a mixed methods study, to explore the practical challenges of this screening and its consequences. The qualitative part interviewed 20 physicians: non psychiatrist physicians and child and adolescent psychiatrists - practicing in various specialized settings. The quantitative part examined self-assessment questionnaires and psychiatric clinical diagnoses in 242 patients admitted for inpatient appraisal of obesity. Results 7.9% reported severe depressive symptoms and 71.9% severe anxiety symptoms. Among this cohort, 28.5% were diagnosed with anxiety disorder and 16.9% with depression disorder. Both qualitative and quantitative data show that a large share of adolescents with obesity experience mental health distress, often intense. However, in most of these adolescents, this distress is not diagnosed as a mental health condition, thus creating a discrepancy which we named a "gray area" of psychological suffering. Conclusions Screening adolescents with obesity for both mental health distress and disease should be systematic. Frontline professionals need improved training and referral pathways and resources.