Evidence-based approach to treating depression.

Sir, Interest in adolescent health is growing. It is recognized that adolescents make decisions about their behaviour which will have important consequences for their future health.1 Adolescents have prominent concerns about their health2 that they want to discuss with their doctor;3 however, general practitioners (GPs) spend less time in consultation with adolescents than with other age groups.4 Little is known about which adolescents use the services, and less is known about how psychiatric and psychosomatic factors influence service use. We performed an analysis of computer records of adolescents aged 13–16 years 11 months, registered with a general practice in London. During a one-year period, 231 of 432 (53.5%) of the adolescents who were registered, attended the practice. The rates of consultation of different age bands within the group were similar, as was that of males versus females. These results differ from Jacobsen, who found significantly increased consulting in 15–19 year old females.5 This suggests that increased consulting by females may only begin at age 17. Among the reasons for consultation, there were no obvious episodes of serious illness. The commonest reasons for consultation were upper respiratory tract infections, asthma, general check-ups, injuries and acne. Psychiatric presenting complaints comprised 3% of presentations including depression, insomnia, enuresis, fear of carcinoma, bullying, and running away. We looked at the relationship between the frequency of attendance and presenting complaint. Twenty-three per cent of adolescents attended four times or more (which we defined as frequent attendance) and accounted for 46% of presentations. This frequent attending was not associated with age or sex, but had differences in presenting complaints. This group had fewer upper respiratiry tract infections and significantly more psychiatric and behavioural complaints. They also had signficantly more vague complaints of a neurological, psychosomatic nature including dizziness, fainting, parasthesias, tiredness and headaches (Table 1). The vast majority of the psychiatric and neurological and psychosomatic complaints occurred in frequent attenders. In light of our findings, the previously held view that adolescents attend primary care infrequently, and that GPs therefore have little opportunity to intervene, is not justified. Although attendance is below the national rate of 78% for all age groups, more than 50% are attending per year. A sizeable minority of adolescents attend frequently. Psychiatric and psychosomatic concerns are more prominent in this group. More research is needed to further clarify what leads these adolescents to consult, and what interventions they receive.