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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

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.

Keywords

Depression Self-harm Adolescents Health services Service use Primary care 

Notes

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.

Conflict of interest

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

References

  1. 1.
    Thapar A, Collishaw S, Pine DS et al (2012) Depression in adolescence. Lancet 379:1056–1067PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Fergusson DM, Horwood LJ, Ridder EM et al (2005) Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry 62:66–72PubMedCrossRefGoogle Scholar
  3. 3.
    Bertha EA, Balázs J (2013) Subthreshold depression in adolescence: a systematic review. Eur Child Adolesc Psychiatry 22:589–603PubMedCrossRefGoogle Scholar
  4. 4.
    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 12:69PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    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 379:236–243PubMedCrossRefGoogle Scholar
  6. 6.
    Hawton K, Rodham K, Evan E et al (2002) Deliberate self harm in adolescents: self report survey in schools in England. BMJ 325:1207–1211PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    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 32:875–891PubMedCrossRefGoogle Scholar
  8. 8.
    Gasquet I, Chavance M, Ledoux S et al (1997) Psychosocial factors associated with help-seeking behavior among depressive adolescents. Eur Child Adolesc Psychiatry 6:151–159PubMedCrossRefGoogle Scholar
  9. 9.
    Schonert-Reichl K, Muller J (1996) Correlates of help-seeking in adolescence. J Youth Adolesc 25:705–731CrossRefGoogle Scholar
  10. 10.
    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 11:114PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    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 5:237–249Google Scholar
  12. 12.
    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 38:565–573PubMedCrossRefGoogle Scholar
  13. 13.
    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 81:259–268CrossRefGoogle Scholar
  14. 14.
    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 43:1052–1063PubMedCrossRefGoogle Scholar
  15. 15.
    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 134:151–159PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Beecham J, Knapp M (2001) Costing psychiatric interventions. In: Thorncroft G (ed) Measuring mental health needs. Gaskell, London, pp 200–224Google Scholar
  17. 17.
    Stallard P, Buck R (2013) Preventing depression and promoting resilience: feasibility study of a school-based cognitive-behavioural intervention. Br J Psychiatry 202:s18–s23CrossRefGoogle Scholar
  18. 18.
    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 34:541–547PubMedCrossRefGoogle Scholar
  19. 19.
    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 52:189–195PubMedCrossRefGoogle Scholar
  20. 20.
    Michelmore L, Hindley P (2012) Help-seeking for suicidal thoughts and self-harm in young people: a systematic review. Suicide Life Threat Behav 42:507–524PubMedCrossRefGoogle Scholar
  21. 21.
    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 34:1536–1543PubMedCrossRefGoogle Scholar
  22. 22.
    Mojtabai R, Olfson M (2008) Parental detection of youth’s self-harm behavior. Suicide Life Threat Behav 38:60–73PubMedCrossRefGoogle Scholar
  23. 23.
    Rickwood DJ, Braithwaite VA (1994) Social-psychological factors affecting help-seeking for emotional problems. Soc Sci Med 39:563–572PubMedCrossRefGoogle Scholar
  24. 24.
    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 6:34PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Kramer T, Garralda ME (1998) Psychiatric disorders in adolescents in primary care. Br J Psychiatry 173:508–513PubMedCrossRefGoogle Scholar
  26. 26.
    Cheung AH, Dewa CS (2007) Mental health service use among adolescents and young adults with major depressive disorder and suicidality. Can J Psychiatry 52:228–232PubMedGoogle Scholar
  27. 27.
    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 44:825–833PubMedCrossRefGoogle Scholar
  28. 28.
    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:e6058PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    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 70:300–310PubMedCrossRefGoogle Scholar
  30. 30.
    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–e314PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Wisdom JP, Clarke GN, Green CA (2006) What teens want: barriers to seeking care for depression. Adm Policy Ment Health 33:122–145CrossRefGoogle Scholar
  32. 32.
    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 8:369PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Gledhill J, Garralda ME (2013) Sub-syndromal depression in adolescents attending primary care: frequency, clinical features and 6 months outcome. Soc Psychiatry Psychiatr Epidemiol 48:735–744PubMedCrossRefGoogle Scholar
  34. 34.
    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 52:539–545PubMedCrossRefGoogle Scholar
  35. 35.
    Young R, Van Beinum M, Sweeting H et al (2007) Young people who self-harm. Br J Psychiatry 191:44–49PubMedCrossRefGoogle Scholar
  36. 36.
    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 48:1193–1201PubMedCrossRefGoogle Scholar
  37. 37.
    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 46:1341–1348PubMedCrossRefGoogle Scholar
  38. 38.
    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 331:1435–1436PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Logan DE, King CA (2002) Parental identification of depression and mental health service use amongst depressed adolescents. J Am Acad Child Adolesc Psychiatry 41:296–304PubMedCrossRefGoogle Scholar

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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