UCL Great Ormond Street Institute of Child Health


Great Ormond Street Institute of Child Health


Early determinants and long-term outcomes of stress-related hospital presentations in adolescents in

Supervisors: Professor Ruth Gilbert, Dr Ruth Blackburn, Professor Astrud Guttmann (University of Toronto)

Early determinants and long-term outcomes of stress-related hospital presentations in adolescents in England and Ontario


Physical, emotional and behavioural manifestations of stress may signal underlying mental health problems in some adolescents. This includes symptoms of pain, such as abdominal pain or headache that are medically unexplained, often in occurrence with other stress presentations including cardiovascular or gastrointestinal symptoms.(Kelly et al., 2010; Thomson et al., 2014) These stress presentations are common and may lead to significant functional and emotional impairments.(Malas et al., 2017) There is evidence of important health inequalities in these presentations, with greater risk among those living in more deprived households, who have experienced family conflict and parental mental illness.(Thomson et al., 2014) Despite the burden of stress symptoms, they are understudied. Factors related to treatment outcomes are particularly poorly understood and there is a need for further research in this area.(Malas et al., 2017).

Largescale administrative data capture health service indicators of stress-presentations that are longitudinal, system-wide and not constrained by medical speciality. Such data are available for England and Ontario, which have comparable healthcare systems and face similar challenges for adolescent mental health care provision. The supervisory team has developed methods for examining stress-related hospital admissions for all adolescents (Gill et al. 2017). Findings for England indicated that 1 in 13 girls and 1 in 25 boys were admitted to hospital with a stress presentation between the ages of 11 and 17 years.(Blackburn et al., 2021)


This research aims to identify early determinants and long-term outcomes of children and young people who attend hospital stress-related presentations in England and Ontario to inform clinical and public health interventions.

1) Identify early determinants of stress for children and young people who later attend hospital with a stress-related presentation
2) Investigate healthcare pathways for adolescents with stress presentations, including the transition into adult healthcare services.
3) Quantify long term outcomes (to 25th birthday) following hospital admission with a stress-related presentation examining patterns of; hospital readmission, repeated A&E contacts, mortality and contact with specialist mental health services
4) Evaluate where structural and contextual differences between England and Ontario may drive differences in the determinants and outcomes that may be mitigated by policy change


Epidemiological analysis of longitudinal hospital data with coverage of all England and all Ontario to examine early determinants and outcomes of stress related presentations in adolescents. This work builds on existing collaborations between the supervisory team in UCL and Ontario, including expertise in the use of administrative data for health services research and international comparison, and code for identifying stress phenotypes.

Collaboration with University of Toronto:

The PhD student will undertake a 6 month placement at Out/ICES in Year 2 of the PhD under the supervision of Astrid Guttmann, who will support the student to integrate into the Institute. During the placement the student will analyse Ontario data to mirror and extend the English studies undertaken in Year 1 of the PhD.

Blackburn, R., Ajetunmobi, O., Mc Grath-Lone, L., Hardelid, P., Shafran, R., Gilbert, R., & Wijlaars, L. (2021). Hospital admissions for stress-related presentations among school-aged adolescents during term time versus holidays in England: weekly time series and retrospective cross-sectional analysis. BJPsych Open, 7(6).
Gill, P. J., Saunders, N., Gandhi, S., Gonzalez, A., Kurdyak, P., Vigod, S., & Guttmann, A. (2017). Emergency Department as a First Contact for Mental Health Problems in Children and Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56(6), 475–482.e4.
Kelly, C., Molcho, M., Doyle, P., & Gabhainn, S. N. (2010). Psychosomatic symptoms among schoolchildren. International Journal of Adolescent Medicine and Health, 22(2).
Malas, N., Ortiz-Aguayo, R., Giles, L., & Ibeziako, P. (2017). Pediatric Somatic Symptom Disorders. Current Psychiatry Reports (Vol. 19, Issue 2).
Thomson, K., Randall, E., Ibeziako, P., & Bujoreanu, I. S. (2014). Somatoform Disorders and Trauma in Medically-Admitted Children, Adolescents, and Young Adults: Prevalence Rates and Psychosocial Characteristics. Psychosomatics.