The study assessed patterns of health service use by adolescents and the association with mental health problems in Alexandria, Egypt. A systematic stratified random sample of 1577 school students aged 14-19 years completed a self-report questionnaire about demographic and health status, use of health services in the previous year, and the Children's Depression Inventory and the Adolescent Self-Report Aggression Scale. Overall, 97.1% of students reported using school health clinics once or more in the year before the study, 93.7% primary health centres, 16.8% mental health services and 13.6% other health services. A history of organic illness in the previous year (OR = 1.80), having depressive symptoms (OR = 2.93) and having aggressive symptoms (OR = 5.53) were significantly associated with frequent use of health services (> or = 4 visits/year).