Contribution of primary care to the approach to mental health

Introduction: child and adolescent mental health represents a growing public health challenge, with a prevalence of psychiatric pathology reaching 25%. In recent years, an alarming increase in self-harm behaviors has been observed, including non-suicidal self-injury and suicidal ideation, which affect up to 16% of pediatric cases.

Material and methods: retrospective observational study analyzes 198 pediatric patients treated at a secondary-level hospital between 2019 and 2024, aiming to evaluate self-harm behaviors and the role of Primary Care in this population.

Results: in our sample, which was predominantly female (71.3%), the prevalence of SHB was 33.3%. Significant risk factors identified included bullying (OR: 2.24) and psychiatric comorbidities (OR: 3.32). Mixed anxiety-depressive disorders presented a ten-fold higher risk of self-harm behaviors compared to isolated anxiety. The value of primary care is reflected in the early diagnosis of cases that eventually reach greater clinical severity. Early referral to specialized mental health services was established as a critical protective factor, significantly reducing the risk of self-harm behaviors (OR: 0.24).

Conclusions: our results underscore that the primary care pediatrician acts as an effective filter for the detection of severe cases. It is imperative to strengthen this level of care with specific training and sufficient resources—both educational and in terms of clinical time—to guarantee a preventive, comprehensive, and coordinated approach to pediatric psychosocial health.