Predictors of Service Utilization Among Youth Diagnosed with Mood Disorders

Abstract

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the Multi-Family Psychoeducational Psychotherapy study (MF-PEP), a randomized controlled trial of 165 children aged 8-12 with mood disorders. The children were using an average of two services, with pharmacotherapy and school services as most frequent. Children with bipolar disorders used significantly more and higher quality services than children with depressive disorders. Parent knowledge of mood disorders, area of residence, and perceived need for treatment were all related to the number of services families were utilizing. Parent knowledge of mood disorders and treatment, child's age, and mood symptom severity were all predictors of the quality of services being utilized. Findings highlight the impact of non-need factors on service utilization and the potential to decrease disparities caused by these factors. For example, increasing efforts to educate both the general public and individual families coming in for treatment about children's mental health may improve service utilization patterns in this population.

First‐episode psychosis: Ongoing mental health service utilization during the stable period for adolescents

“…First‐degree family psychopathology, specifically depression, has been shown to have higher levels of treatment barriers with youth . This study did not find the presence of a first‐degree family member with schizophrenia to be associated ongoing service utilization; however, having a first‐degree relative with depression may negatively influence the adolescent's ongoing service utilization.…”

“…6,36 Many factors have been found to be associated with disruption to ongoing psychiatric service utilization for youth with major psychiatric disorders. [37][38][39] Individuals with schizophrenia who disengage from treatment tend to be younger, males, ethnic/racial minorities, socially isolated, have earlier onset of psychosis, a co-occurring substance-use disorder and/or additional psychiatric disorders. 34 Other variables consistently found in the literature to influence discontinuation of medication and psychosocial treatment for FEP are symptom severity, [40][41][42][43][44][45] longer duration of untreated psychosis, 40,46-48 poorer insight, 41,42,47,49,50 substance use 47,51 and lack of involvement of a family member.…”

“…Sustained psychiatric treatment has been shown to improve functioning and decrease both clinical symptoms and relapse for individuals experiencing FEP and adherence to medication and psychosocial treatment is important to improve the course of the illness . Many factors have been found to be associated with disruption to ongoing psychiatric service utilization for youth with major psychiatric disorders . Individuals with schizophrenia who disengage from treatment tend to be younger, males, ethnic/racial minorities, socially isolated, have earlier onset of psychosis, a co‐occurring substance‐use disorder and/or additional psychiatric disorders .…”

“…Although a common reason for service disengagement is ‘feeling better’, a greater effort extended by families and treatment teams to engage and maintain those with more severe disorders in treatment may be needed . Parental psychopathology represents substantial barriers to service utilization and this may increase the risk of premature service discontinuation for FEP at a time when involvement is important. The presence of these predictors is a significant starting point for identifying adolescents who may be at heightened risk for discontinuing services prematurely and for identifying areas where clinicians may be able to intervene to improve continued service utilization for adolescents following their FEP.…”

Correlates of psychiatric hospitalization in a clinical sample of Canadian adolescents with bipolar disorder

“…Annual rates in children and adolescents increased 434% between 1997 and 2010 [29], which coincided with a large increase in number of BD diagnoses for this age group [30,31]. Adolescents with BD are hospitalized more often than those with most other psychiatric and behavioral disorders [34][35][36][37], and rates of inpatient service use now exceed even those of adults with BD in some reports [22]. Female gender [38,39], comorbid health conditions [39] and having a parent with SUD [38] have all been shown to be directly associated with hospitalization in adolescents with BD, while suicidal or self-injurious behavior [35], comorbid physical conditions in general [39] and rapid cycling [38] are associated with use of highly restrictive treatment settings.…”