Abstract
Purpose
Although depression and self-harm are common mental health problems in adolescents, there are barriers to accessing help. Using a community-based sample, this study investigates predictors of service contacts for adolescents at high risk of depression and self-harm.
Methods
Three thousand seven hundred and forty-nine (3,749) 12- to 16-year-olds in UK secondary (high) schools provided baseline and 6 months’ follow-up data on mood, self-harm and service contacts with a range of primary and secondary healthcare services.
Results
Although most adolescents at high risk of depression or self-harm had seen their general practitioner (GP) in the previous 6 months, less than one-third had used primary or secondary healthcare services for emotional problems. 5 % of adolescents who reported self-harm had seen specialist child and adolescent mental health services in the previous 6 months. In longitudinal analyses, after adjustment for confounders, both depression and self-harm predicted the use of any healthcare services [adjusted odds ratio (AOR) = 1.34 (95 % CI 1.09, 1.64); AOR = 1.38 (95 % CI 1.02, 1.86), respectively] and of specialist mental health services [AOR = 5.48 (95 % CI 2.27, 13.25); AOR = 2.58 (95 % CI 1.11, 6.00), respectively]. Amongst those with probable depression, 79 % had seen their GP and 5 % specialist mental health services in the preceding year.
Conclusions
Most adolescents at high risk of depression or self-harm see their GP over a 6-month period although only a minority of them access specialist mental health services. Their consultations within primary care settings provide a potential opportunity for their identification and for signposting to appropriate specialist services.
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References
Thapar A, Collishaw S, Pine DS et al (2012) Depression in adolescence. Lancet 379:1056–1067
Fergusson DM, Horwood LJ, Ridder EM et al (2005) Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry 62:66–72
Bertha EA, Balázs J (2013) Subthreshold depression in adolescence: a systematic review. Eur Child Adolesc Psychiatry 22:589–603
Kidger J, Heron J, Lewis G et al (2012) Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England. BMC Psychiatry 12:69
Moran P, Coffey C, Romaniuk H et al (2012) The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet 379:236–243
Hawton K, Rodham K, Evan E et al (2002) Deliberate self harm in adolescents: self report survey in schools in England. BMJ 325:1207–1211
Ystgaard M, Arensman E, Hawton K et al (2009) Deliberate self-harm in adolescents: comparison between those who receive help following self-harm and those who do not. J Adolesc 32:875–891
Gasquet I, Chavance M, Ledoux S et al (1997) Psychosocial factors associated with help-seeking behavior among depressive adolescents. Eur Child Adolesc Psychiatry 6:151–159
Schonert-Reichl K, Muller J (1996) Correlates of help-seeking in adolescence. J Youth Adolesc 25:705–731
Stallard P, Montgomery AA, Araya R et al (2010) Protocol for a randomised controlled trial of a school based cognitive behavior therapy (CBT) intervention to prevent depression in high risk adolescents (PROMISE). Trials 11:114
Angold A, Costello E, Messer S et al (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Meth Psych Res 5:237–249
Kent L, Vostanis P, Feehan C (1997) Detection of major and minor depression in children and adolescents: evaluation of the mood and feelings questionnaire. J Child Psychol Psychiatry 38:565–573
Thapar A, McGuffin P (1997) Validity of the shortened mood and feelings questionnaire in a community sample of children and adolescents: a preliminary research note. Psychiatry Res 81:259–268
Angold A, Erkanli A, Silberg J et al (2002) Depression scale scores in 8–17-year-olds: effects of age and gender. J Child Psychol Psychiatry 43:1052–1063
McKenzie D, Toumbourou J, Forbes A et al (2011) Predicting future depression in adolescents using the short mood and feelings questionnaire: a two-nation study. J Affect Disord 134:151–159
Beecham J, Knapp M (2001) Costing psychiatric interventions. In: Thorncroft G (ed) Measuring mental health needs. Gaskell, London, pp 200–224
Stallard P, Buck R (2013) Preventing depression and promoting resilience: feasibility study of a school-based cognitive-behavioural intervention. Br J Psychiatry 202:s18–s23
Mirandola M, Bisoffi G, Bonizzato P (1999) Collecting psychiatric resources utilisation data to calculate costs of care: a comparison between a service receipt interview and a case register. Soc Psychiatry Psychiatr Epidemiol 34:541–547
Wu P, Hoven CW, Cohen P et al (2001) Factors associated with use of mental health services for depression by children and adolescents. Psychiatr Serv 52:189–195
Michelmore L, Hindley P (2012) Help-seeking for suicidal thoughts and self-harm in young people: a systematic review. Suicide Life Threat Behav 42:507–524
Cuffe SP, Waller JL, Cuccaro ML et al (1995) Race and gender differences in the treatment of psychiatric disorders in young adolescents. J Am Acad Child Adolesc Psychiatry 34:1536–1543
Mojtabai R, Olfson M (2008) Parental detection of youth’s self-harm behavior. Suicide Life Threat Behav 38:60–73
Rickwood DJ, Braithwaite VA (1994) Social-psychological factors affecting help-seeking for emotional problems. Soc Sci Med 39:563–572
Zachrisson HD, Rödje K, Mykletun A (2006) Utilization of health services in relation to mental health problems in adolescents: a population based survey. BMC Public Health 6:34
Kramer T, Garralda ME (1998) Psychiatric disorders in adolescents in primary care. Br J Psychiatry 173:508–513
Cheung AH, Dewa CS (2007) Mental health service use among adolescents and young adults with major depressive disorder and suicidality. Can J Psychiatry 52:228–232
Ferrin M, Gledhill J, Kramer T, Garralda ME (2009) Factors influencing primary care attendance in adolescents with high levels of depressive symptoms. Soc Psychiatry Psychiatr Epidemiol 44:825–833
Stallard P, Sayal K, Phillips R et al (2012) Classroom based cognitive behaviour therapy in reducing symptoms of depression in high risk adolescents: a pragmatic randomised controlled trial. BMJ 345:e6058
Nock MK, Green JG, Hwang I et al (2013) Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 70:300–310
Mauerhofer A, Berchtold A, Michaud PA et al (2009) GPs’ role in the detection of psychological problems of young people: a population-based study. Br J Gen Pract 59:e308–e314
Wisdom JP, Clarke GN, Green CA (2006) What teens want: barriers to seeking care for depression. Adm Policy Ment Health 33:122–145
Fortune S, Sinclair J, Hawton K (2008) Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England. BMC Public Health 8:369
Gledhill J, Garralda ME (2013) Sub-syndromal depression in adolescents attending primary care: frequency, clinical features and 6 months outcome. Soc Psychiatry Psychiatr Epidemiol 48:735–744
Kramer T, Iliffe S, Bye A et al (2013) Testing the feasibility of therapeutic identification of depression in young people in British general practice. J Adolesc Health 52:539–545
Young R, Van Beinum M, Sweeting H et al (2007) Young people who self-harm. Br J Psychiatry 191:44–49
Gould MS, Marrocco FA, Hoagwood K et al (2009) Service use by at-risk youths after school-based suicide screening. J Am Acad Child Adolesc Psychiatry 48:1193–1201
Kataoka S, Stein BD, Nadeem E et al (2007) Who gets care? Mental health service use following a school-based suicide prevention program. J Am Acad Child Adolesc Psychiatry 46:1341–1348
Ford T, Sayal K, Meltzer H et al (2005) Parental concerns about their child’s emotions and behaviour and referral to specialist services: general population survey. BMJ 331:1435–1436
Logan DE, King CA (2002) Parental identification of depression and mental health service use amongst depressed adolescents. J Am Acad Child Adolesc Psychiatry 41:296–304
Acknowledgments
We thank the schools and students who participated in this project, the PROMISE research team for data collection, and the East Midlands Hub of the NIHR Mental Health Research Network for their administrative and research support. The PROMISE study was funded by the National Institute for Health Research Health Technology Assessment.
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Sayal, K., Yates, N., Spears, M. et al. Service use in adolescents at risk of depression and self-harm: prospective longitudinal study. Soc Psychiatry Psychiatr Epidemiol 49, 1231–1240 (2014). https://doi.org/10.1007/s00127-014-0843-y
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DOI: https://doi.org/10.1007/s00127-014-0843-y