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Defining adolescent common mental disorders using electronic primary care data: a comparison with outcomes measured using the CIS-R
  1. Rosie P Cornish1,
  2. Ann John2,3,
  3. Andy Boyd1,
  4. Kate Tilling1,4,
  5. John Macleod1
  1. 1School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2Farr Institute, Swansea University Medical School, Swansea, UK
  3. 3Public Health Wales NHS Trust, Wales, UK
  4. 4Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  1. Correspondence to Rosie P Cornish; rosie.cornish{at}


Objective To compare the prevalence of common mental disorders (CMDs) derived from data held in primary care records with that measured using the revised Clinical Interview Schedule (CIS-R) in order to assess the potential robustness of findings based only on routinely collected data.

Design and setting Comparison study using linkage between the Avon Longitudinal Study of Parents and Children (ALSPAC) and electronic primary care records.

Participants We studied 1562 adolescents who had completed the CIS-R in ALSPAC at age 17–18 years and had linkage established to their primary care records.

Outcome measures Outcome measures from ALSPAC were whether or not an individual met International Classification of Diseases-10 criteria for a diagnosis of (1) a CMD or, specifically, (2) depression. Lists of Read codes corresponding to diagnoses, symptoms and treatments were used to create 12 definitions of CMD and depression alone using the primary care data. We calculated sensitivities and specificities of these, using CIS-R definitions as the reference standard.

Results Sensitivities ranged from 5.2% to 24.3% for depression and from 3.8% to 19.2% for CMD. The specificities of all definitions were above 98% for depression and above 96% for CMD.

For both outcomes, the definition that included current diagnosis, treatment or symptoms identified the highest proportion of CIS-R cases.

Conclusions Most individuals meeting case definitions for CMD based on primary care data also met CIS-R case definitions. Conversely many individuals identified as cases using the CIS-R had no evidence of CMD in their clinical records. This suggests that clinical databases are likely to yield underestimates of the burden of CMD in the population. However, clinical records appear to yield valid diagnoses which may be useful for studying risk factors and consequences of CMD. The greatest epidemiological value may be obtained when information is available from survey and clinical records.

  • depression
  • common mental disorders
  • data linkage
  • electronic patient records
  • CIS-R

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  • Contributors RPC and AJ conceived the study. RC conducted the statistical analyses, and wrote the first draft of the manuscript. JM, KT and AJ contributed to the interpretation of the results. AB designed and established the linkage and data management processes. All authors contributed to the design of the study and the drafting of the manuscript. All authors have read and approved the final version.

  • Funding This work was supported by the UK Medical Research Council (MR/L012081/1) and the Wellcome Trust (WT086118/Z/08/Z). AJ and JM acknowledge support from The Farr Institute CIPHER, which is supported by a 10-funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), and the Wellcome Trust (MRC grant number MR/K006525/1). The UK Medical Research Council (MRC) and the Wellcome Trust (grant reference 102215/2/13/2) and the University of Bristol currently provide core support for ALSPAC.

  • Competing interests None declared.

  • Ethics approval Avon Longitudinal Study of Parents and Children Ethics and Law Committee and the Local Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Information about access to ALSPAC data is given on the website (

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