title: The youngest children in each school cohort are overrepresented in referrals to mental health services.
abstract: OBJECTIVE
  To investigate whether the youngest children in each school cohort are overrepresented as users of specialist mental health services.
  
  
  METHODS
  Dates of birth were obtained for all 9,157 children and adolescents referred to specialist mental health services in 3 London boroughs from 2008 to 2011. The actual frequency of referrals by month of birth is compared to the expected frequency of referrals as determined by birth statistics for the relevant age group.
  
  
  RESULTS
  August-born children, who are the youngest in their cohorts in England, represent 9.38% of referrals but only 8.59% of the population in the relevant age segment. Hence, August-born children are overrepresented in referrals to specialist mental health services (P value = .007). September- and October-born children, who are the oldest in their cohorts, are underrepresented: September-born children represent 8.62% of the population but 7.99% of referrals to mental health services (P value = .032), and October-born children are 8.56% of the population but 7.86% of referrals (P value = .016).
  
  
  CONCLUSIONS
  Being among the youngest in a school cohort is associated with a higher risk of referral to mental health services, while being among the oldest is a protective factor.
authors.affiliation: Higher Training Scheme in Child and Adolescent Psychiatry, Great Ormond Street and Royal London Hospitals, London.
authors.forename: Shipra
authors.initials: S
authors.lastname: Berg
authors.forename: Erlend
authors.initials: E
authors.lastname: Berg
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008131:London / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012306:Risk; D012574:Schools / Q000706:statistics & numerical data*; D013997:Time Factors