The Youngest Children in Each School Cohort Are Overrepresented in Referrals to Mental Health Services

Objective: To investigate whether the youngest children in each school cohort are over-represented as users of specialist mental health services. Methods: Dates of birth were obtained for all 9157 children and adolescents referred to specialist mental health services in three 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 over-represented in referrals to specialist mental health services (p-value 0.007). September- and October-born children, who are the oldest in their cohorts, are under-represented: September-born children represent 8.62% of the population but 7.99% of referrals to mental health services (p-value 0.032) and October-born children are 8.56% of the population but 7.86% of referrals (p-value 0.016). Conclusion: 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.