title: Service use in adolescents at risk of depression and self-harm: prospective longitudinal study.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Psychiatry and Applied Psychology & Institute of Mental Health, University of Nottingham, E Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK, kapil.sayal@nottingham.ac.uk.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sayal
authors.forename: Nichola
authors.initials: N
authors.lastname: Yates
authors.forename: Melissa
authors.initials: M
authors.lastname: Spears
authors.forename: Paul
authors.initials: P
authors.lastname: Stallard
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D002648:Child; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012574:Schools; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult