Mental health of young adult patients who do not attend appointments in primary care: a retrospective cohort study.

Objective: The objective is to examine the relation between young adults' non-attendance at primary care appointments and mental health problems, using a retrospective cohort study, in a urban primary health care facility in a relatively deprived and ethnically diverse area of Oxford, England.

Methods: Two hundred and nine patients aged between 15 and 35 years who failed to attend a doctor's appointment in primary care during 2008 each matched with two control patients of the same age and gender who had attended appointments during the same period. Main outcome measure is the presentation with a mental health problem within 12 months following the missed appointment.

Results: Non-attendance in primary care among 15-35 year olds was strongly associated with presentation of mental health problems. Those who did not attend an appointment were more likely to have presented mental health problems in the past [31.0% versus 8.9%, odds ratio (OR) 4.72, 95% confidence interval (CI) 3.00-7.42] and to present mental health problems within the ensuing 12 months (32.0% versus 7.4%, OR 5.91, 95% CI 3.69-9.46) when compared with those who attended appointments. Patients with no known past history of mental health problems were more likely to make their first recorded mental health presentation in the 12 months following a non-attendance when compared with those who attended (10.3% versus 3.1%, OR 3.60, 95% CI 1.76-7.35).

Conclusions: Non-attendance of a young adult for a doctor's appointment in primary care may signal a mental health problem. This applies whether or not the patient is known to have presented mental health problems in the past.