Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 8, pp 1231–1240 | Cite as

Service use in adolescents at risk of depression and self-harm: prospective longitudinal study

  • Kapil Sayal
  • Nichola Yates
  • Melissa Spears
  • Paul Stallard
Original Paper



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.


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.


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.


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.


Depression Self-harm Adolescents Health services Service use Primary care 



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.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kapil Sayal
    • 1
  • Nichola Yates
    • 2
  • Melissa Spears
    • 3
  • Paul Stallard
    • 4
  1. 1.Division of Psychiatry and Applied Psychology & Institute of Mental HealthUniversity of NottinghamNottinghamUK
  2. 2.School of Social and Community MedicineUniversity of BristolBristolUK
  3. 3.Medical Research Council Clinical Trials UnitLondonUK
  4. 4.Child and Adolescent Mental Health Research Group, Department of HealthUniversity of BathBathUK

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