Skip to main content
SpringerLink
Log in

Factors influencing primary care attendance in adolescents with high levels of depressive symptoms

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Although depression is common amongst adolescents attending general practice, little is known about factors which influence consultation. This study aims to identify factors that contribute to GP attendance in adolescents with high levels of mood symptoms.

Methods

Case–control study of 13 to 17-year-olds attending (cases, N = 156) and not attending (controls, N = 120) an urban general practice during a 6-month period; questionnaires on depressive symptoms (Mood and Feelings Questionnaire), physical symptoms (Child Somatisation Inventory), socio-demographic data and attitudes were completed.

Results

Attenders had significantly more depressive and physical symptoms. In the comparison between 63 attenders and 34 non-attenders with a high level of depressive symptoms, attendance was significantly linked to lower socio-economic status, non-White ethnicity, non-intact families, and not believing that doctors are only interested in physical symptoms. On logistic regression analysis, attendance in males with depressive symptoms was predicted by more physical and less marked depressive symptoms; in females by non-White ethnicity and not believing doctors are only interested in physical symptoms.

Conclusion

Both socio-demographic factors and adolescent attitudes influence general practitioner attendance in adolescents with high levels of depressive symptoms. These findings may help inform interventions to facilitate help seeking in primary care for young people with high levels of depressive symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Angold A, Weissmann MM, Merikangas KR, Prusoff P, Wickramaratne G, Gammon GD, Warner V (1987) Parent and child reports of depressive symptoms in children at low and high risk of depression. J Child Psychol Psychiatry 28:901–915

    Article  PubMed  CAS  Google Scholar 

  2. Asarnow JR, Jaycox LH, Duan N, LaBorde AP, Rea MM et al (2005) Depression and role impairment among adolescents in primary care clinics. J Adolesc Health 37:477–483

    Article  PubMed  Google Scholar 

  3. Arsanow JR, Jaycox LH, Duan N, LaBorde AP, Rea MM et al (2005) Effectiveness of a quality improvement intervention for adolescent depression in primary care. A randomized control trial. J Am Med Assoc 293:311–319

    Article  Google Scholar 

  4. Bowman FM, Garralda ME (1993) Psychiatric morbidity among children who are frequent attenders in general practice. Br J Gen Pract 43:6–9

    PubMed  CAS  Google Scholar 

  5. Burns JJ, Cottrell L, Perkins K, Pack R, Stanon B et al (2004) Depressive symptoms and health risk among rural adolescents. Pediatrics 113:1313–1320

    Article  PubMed  Google Scholar 

  6. Colman I, Wadsworth MEJ, Croudace TJ, Jones PB (2007) Forty-year psychiatric outcomes following assessment for internalizing disorders in adolescence. Am J Psychiatry 164:126–133

    Article  PubMed  Google Scholar 

  7. Cooper PJ, Goodyer I (1993) A community study of depression in adolescent girls. I: Estimates of symptom and syndrome prevalence. Br J Psychiatry 163:369–374

    Article  PubMed  CAS  Google Scholar 

  8. Costello E, Angold A, Burns B, Erkanli A, Stangl DK et al (1996) The Great Smoky Mountains Study of Youth; functional impairment and serious emotional disturbance. Arch Gen Psychiatry 53:1137–1143

    PubMed  CAS  Google Scholar 

  9. Dunn V, Goodyer IM (2006) Longitudinal investigation into childhood and adolescence onset depression: psychiatric outcome in early adulthood. Br J Psychiatry 188:216–222

    Article  PubMed  Google Scholar 

  10. Essau CA (2007) Course and outcome of major depressive disorder in non-referred adolescents. J Affect Disord 99:191–201

    Article  PubMed  Google Scholar 

  11. Ford T, Goodman R, Meltzer H (2003) The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry 42:1203–1211

    Article  PubMed  Google Scholar 

  12. Fröjd S, Narttunen M, Pelkonen M, von der Pahlen B, Kaltiala-Heino R (2007) Adult and peer involvement in help-seeking for depression in adolescent population. A two-year follow-up in Finland. Soc Psychiatry Psychiatr Epidemiol 42:945–952

    Article  PubMed  Google Scholar 

  13. Garber J, Walker L, Zeman J (1991) Somatization symptoms in a community sample of children and adolescents: further validation of the children’s somatisation inventory. J Consult Clin Psychol 3:588–595

    Google Scholar 

  14. Gledhill J, Kramer T, Iliffe S, Garralda ME (2003) Training general practitioners in the identification and management of adolescent depression within the consultation: a feasibility study. J Adolesc 26:245–250

    Article  PubMed  Google Scholar 

  15. Harrington R, Fudge H, Rutter M, Pickles A, Hill J (1990) Adult outcomes of child and adolescent depression. I. Psychiatric status. Arch Gen Psychiatry 47:465–473

    PubMed  CAS  Google Scholar 

  16. Jorm AF, Wright A, Morgan AJ (2007) Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents. Med J Aust 187:556–560

    PubMed  Google Scholar 

  17. Kramer T, Iliffe S, Murray E, Waterman S (1997) Which adolescents attend the GP? Br J Gen Pract 47:327

    PubMed  CAS  Google Scholar 

  18. Kramer T, Garralda ME (1998) Psychiatric disorders in adolescents in primary care. Br J Psychiatry 173:508–513

    Article  PubMed  CAS  Google Scholar 

  19. Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA (1993) Adolescent psychopathology. I: Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 102:133–134

    Article  PubMed  CAS  Google Scholar 

  20. Lewinsohn PM, Rhode P, Klein DN, Seeley JR (1999) Natural course of adolescent major depressive disorder. I: Continuity into young adulthood. J Am Acad Child Adolesc Psychiatry 38:56–63

    Article  PubMed  CAS  Google Scholar 

  21. Martinez R, Reynolds S, Howe A (2006) Factors that influence the detection of psychological problems in adolescents attending general practices. Br J Gen Pract 56:594–599

    PubMed  Google Scholar 

  22. National Institute for Health and Clinical Excellence NICE (2005) Depression in children and young people. http://guidance.nice.org.uk/CG28/niceguidance/pdf/English

  23. Office of Population Censuses and Surveys (1980) Classification of occupations. Her Majesty Stationery Office, London

  24. Offord DR, Boyle MH, Szatmari P, Rae-Grant NI, Links PS et al (1987) Ontario Child Health Study. II. Six month prevalence of disorder and rates of service utilization. Arch Gen Psychiatry 44:832–836

    PubMed  CAS  Google Scholar 

  25. Pelkonen M, Marttunen M, Aro H (2003) Risk for depression: a 6-year follow-up of Finnish adolescents. J Affect Disord 77:41–51

    Article  PubMed  Google Scholar 

  26. Prince M, Stewart R, Ford T, Hotopf M (2003) Practical psychiatric epidemiology. Oxford University Press, New York, p 28

    Google Scholar 

  27. Rao U, Hammen C, Daley S (1999) Continuity of depression during the transition to adulthood: a 5-year longitudinal study of young women. J Am Acad Child Adolesc Psychiatry 38:908–915

    Article  PubMed  CAS  Google Scholar 

  28. Read JD (1990) Royal College of general practitioners members reference book. RCGP, London

    Google Scholar 

  29. Robson J, Falshaw M (1995) Audit of preventive activities in 16 inner London practices using a validated measure of patient population, the ‘active patient’ denominator. Br J Gen Pract 45:463–466

    PubMed  CAS  Google Scholar 

  30. Sen B (2004) Adolescent propensity for depressed mood and help seeking: race and gender differences. J Ment Health Policy Econ 7:133–145

    PubMed  Google Scholar 

  31. Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P et al (1999) Depressed adolescents grown up. J Am Med Assoc 281:1707–1713

    Article  CAS  Google Scholar 

  32. Wood A, Kroll L, Moore A, Harrington R (1995) Properties of the Mood and Feelings Questionnaire in adolescent psychiatric outpatients: a research note. J Child Psychol Psychiatry 36:327–334

    Article  PubMed  CAS  Google Scholar 

  33. Yates P, Kramer T, Garralda ME (2004) Depressive symptoms amongst adolescents primary care attenders. Levels and associations. Soc Psychiatry Psychiatr Epidemiol 39:588–594

    Article  PubMed  Google Scholar 

  34. Zuckerbrot RA, Jensen PS (2006) Improving recognition of adolescent depression in primary care. Arch Pediatr Adolesc Med 160:694–704

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the GPs, adolescents and families who participated in the study. We are grateful to Dr. Emma Sedgwick for her help with data collection, to Daniel Stahl for statistical advice, and to Dr. Miguel Ruiz-Veguilla for his helpful comments.

Conflict of interest statement

Dr. Ferrin is partially supported by grants from the Instituto de Salud Carlos III (Plan Nacional I+D+I 2007) and from the Fundacion Alicia Koplowitz. No other conflicts declared.

Author information

Authors and Affiliations

  1. Unidad de Psiquiatria Infanto-Juvenil, Complejo Hospitalario de Jaen, Carretera Bailen-Motril s/n, 23009, Jaén, Spain

    Maite Ferrin

  2. The Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG, UK

    Julia Gledhill, Tami Kramer & M. Elena Garralda

  3. Central and North West London NHS Foundation Trust, London, UK

    Julia Gledhill, Tami Kramer & M. Elena Garralda

Authors
  1. Maite Ferrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Gledhill
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tami Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Elena Garralda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julia Gledhill.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferrin, M., Gledhill, J., Kramer, T. et al. Factors influencing primary care attendance in adolescents with high levels of depressive symptoms. Soc Psychiat Epidemiol 44, 825–833 (2009). https://doi.org/10.1007/s00127-009-0004-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-009-0004-x

Keywords

Search

Navigation