Skip to main content Accessibility help

Psychiatric disorders in adolescents in primary care

  • Tami Kramer (a1) and M. Elena Garralda (a1)



Little is known about psychiatric disorders in adolescents who attend primary care.


Prospective study of 13- to 16-year-olds consecutively attending general practice. Information was obtained from adolescents, parents and general practitioners, using questionnaires and research interviews.


136/200 (68%) of adolescent attenders took part. Two per cent presented with psychiatric complaints. From research interviews with adolescents, psychiatric disorder in the previous year was found in 38%, with moderate impairment of functioning in over half (according to Children's Global Assessment Scale scores). Most disorders (42/50, 84%) were emotional (‘internalising’) disorders. Psychiatric disorders were significantly associated with high levels and intensity of physical symptoms and with increased health risks. General practitioner assessment of psychiatric disorders was low on sensitivity (20.8%) but high on specificity (90.7%). Doctors identified most severely affected adolescents.


Depressive and anxiety disorders are common among adolescent general practice attenders and linked to increased physical symptoms; general practitioner recognition is limited.


Corresponding author

Professor M. E. Garralda, Section of Child and Adolescent Psychiatry, Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine, St Mary's Campus. Academic Unit of Child and Adolescent Psychiatry, Norfolk Place, London W2 1PG


Hide All
Achenbach, T. M. (1991) Manual for the Child Behaviour Checklist/4–18 and 1991 Profile. Buttlington, VT: University of Vermont Department of Psychiatry.
Ambrosini, P. J., Metz, C., Prabucki, K., et al (1989) Video-tape reliability of the third revised edition of the K–SADS. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 723728.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Bernstein, G. A., Massie, E. D., Thums, P. D., et al (1997) Somatic symptoms in anxious – depressed school refusers. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 661668.
Bird, H. R., Yager, T. J., Stagezza, B., et al (1990) Impairment in the epidemiological measurement of childhood psychopathology in the community. Journal of the American Academy of Child Adolescent Psychiatry, 29, 796803.
Bowman, F. M. & Garralda, M. E. (1993) Psychiatric morbidity among children who are frequent attenders in general practice. British Journal of General Practice, 43, 69.
Cantwell, D. P., Lewinsohn, P. M., Rhode, P., et al (1997) Correspondence between adolescent report and parent report of psychiatric diagnostic data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 610619.
Chambers, W., Puig-Antich, J., Hirsch, M., et al (1985) The assessment of affective disorders in children and adolescents by semistructured interview. Archives of General Psychiatry, 42, 696702.
Garber, J., Walker, L. & Zeman, J. (1991) Somatization symptoms in a community sample of children and adolescents: further validation of the Children's Somatization Inventory. Journal of Consulting and Clinical Psychology, 3, 588595.
Garralda, M. E. (1994) Primary care psychiatry. In Child and Adolescent Psychiatry: Modern approaches (eds Rutter, M., Taylor, E. & Hersov, L.), pp. 10551070. Oxford: Blackwell Scientific.
Garralda, M. E., Bowman, F. M. & Mandalia, S. (1998) Children with psychiatric disorders who are frequent attenders to primary care. European Child and Adolescent Psychiatry, in press.
Goldberg, D. (1978) Manual of the General Health Questionnaire. Windsor: NFER – Nelson.
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community. The Pathway to Psychiatric Care. London: Tavistock.
Leaf, P. J., Alegria, M., Cohen, P., et al (1996) Mental health service use in the community and schools: results from the Four-Community MEGA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 889897.
Lewinsohn, P. M., Gregory, N. C., Seeley, J. R., et al (1994) Major depression in community adolescents: age of onset, episode duration and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 809818.
Monck, E., Graham, P., Richman, N., et of (1994) Adolescent girls I. Self-reported mood disturbance in a community population. British Journal of Psychiatry, 165, 760769.
Read, J. D. (1990) Royal College of General Practitioners Members Reference book. London: RCGP.
Swadi, H. (1992) A longitudinal perspective on adolescent substance abuse. European Child and Adolescent Psychiatry, 1, 156170.
Verhulst, F. C. & Koot, H. M. (eds) (1995) The Epidemiology of Child and Adolescent Psychopathology Oxford: Oxford University Press.
Westman, A. & Garralda, M. E. (1996) Mental health promotion for young adolescents in primary care: a feasibility study. British Journal of General Practice, 46, 317.
Wood, A., Moore, A., Harrington, R., et al (1996) Clinical validity of major depression – endogenous subtype in adolescent patients. European Child and Adolescent Psychiatry, 5, 155161.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Psychiatric disorders in adolescents in primary care

  • Tami Kramer (a1) and M. Elena Garralda (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *