Psychosocial abnormalities (ICD-10, Axis V) in child psychiatric out-patients: Relationships with patterns of referral, diagnosis and attendance

This study investigated the diagnostic and abnormal psychosocial situations experienced by children referred to a district child psychiatry service (N = 71), in relation to the source of referral and attendance pattern. ICD-10 diagnoses (Axis I) and abnormal psychosocial situations (Axis V) were recorded by the assessing clinician. The majority of children had been referred by General Practitioners and Paediatricians, had a broad diagnosis of emotional and/or conduct disorder, and high rates of abnormal intrafamilial relationships, family mental disorder and inadequate family communication, as detected by the Axis V form. Paediatricians referted older children with a significantly higher number of psychosocial abnormalities. Emotional disturbance was associated with acute life events and school-related chronic stressors, and conduct disorders with abnormal immediate environment. Although the total number of psychosocial factors was not found to predict attendance pattern or status at six months, children from abnormal immediate environments (eg. institutional upbringing) were more likely to have lapsed from treatment, and children who had experienced acute life events were less likely to be in attendance at six months. The inclusion of such brief indices of clinical severity in clinical settings, in addition to diagnostic categories, may be useful for audit purposes and service evaluation.