Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A)

Abstract

Objective Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation are to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement (NCS-A). Method Face-to-face survey of mental disorders from 2002-2004 using a modified version of the fully-structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents aged 13-18 years for whom information on service use was available from both an adolescent and a parent report. Both total and sector-specific mental health service use was also assessed. Results Approximately one-third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest among those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but less than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly among youth with behavior disorders. Hispanic and non-Hispanic black adolescents were less likely than their white counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. Conclusions Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

“…1 Despite these substantial numbers, fewer than half of US children with mental health conditions receive the care they need. 2,3 The American Academy of Pediatrics (AAP) has addressed this gap in services by encouraging primary care providers (PCPs) to take a more active role in preventing, identifying, and managing mental health conditions. The AAP released guidelines on the treatment of ADHD in 2000 and recommended a greater role for primary care for all mental health conditions in 2009, and an expert steering group in 2007 outlined ways PCPs could be involved with adolescents with depression.…”

Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents

“…For example, 20% of younger adolescents (10-15 years) and 27% of older adolescents (16-17 years) did not receive annual well-child visits, and 64% of adolescents with mental disorders did not receive services to address their illnesses. [27][28][29] Furthermore, those from disadvantaged backgrounds are at the highest risk of not having regular health maintenance visits or receiving needed mental health care. 27,[29][30][31] Many adolescents also tend to engage in health behaviors that place them at risk for the leading causes of morbidity and mortality.…”

“…[27][28][29] Furthermore, those from disadvantaged backgrounds are at the highest risk of not having regular health maintenance visits or receiving needed mental health care. 27,[29][30][31] Many adolescents also tend to engage in health behaviors that place them at risk for the leading causes of morbidity and mortality. 32 As adolescents begin to gain greater independence and assume individual responsibility for daily health habits, develop new social relationships, and individuate from their parents, these changes bring new opportunities and challenges for improving health and preventing disease.…”

Developments and challenges in the diagnosis and treatment of ADHD

“…In the U.S., less than two-thirds of adolescents with ADHD had ever received some kind of treatment. 8 This situation is even more dramatic in low-and middleincome countries. For example, in a community sample of two cities in Brazil that ascertained approximately 10,000 children, 43% of children with ADHD had been previously referred to mental health services, but only 23% had access to some kind of treatment (A Graeff-Martins, personal communication).…”