Treatment of mental illness in American adolescents varies widely within and across areas

Cuddy, Emily; Currie, Janet

doi:10.1073/pnas.2007484117

Cited by 23 publications

(12 citation statements)

References 26 publications

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“…Medications might be prescribed by primary care providers and other licensed mental health providers ( 103 ). The Food and Drug Administration (FDA) has approved medications for childhood mental disorders such as ADHD, depression, anxiety, and ASD; however, many medications for mental disorders are prescribed without specific FDA approval for use in children and without following standard care guidelines ( 104 , 105 ). Medication might be more effective if carefully titrated and used in combination with behavioral treatment ( 95 ).…”

Section: Resultsmentioning

confidence: 99%

Mental Health Surveillance Among Children — United States, 2013–2019

Bitsko¹,

Claussen²,

Lichstein³

et al. 2022

MMWR Suppl.

674

206

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Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance. US Department of Health and Human Services/Centers for Disease Control and Prevention provisions for children with preexisting conditions (e.g., the Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act) (51-54).This report updates and expands the 2013 surveillance report on mental health among children (8). Similar to the 2013 report, this report provides an overview of nine federal surveillance system...

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Section: Resultsmentioning

confidence: 99%

Mental Health Surveillance Among Children — United States, 2013–2019

Bitsko¹,

Claussen²,

Lichstein³

et al. 2022

MMWR Suppl.

674

206

View full text Add to dashboard Cite

show abstract

“…These considerations suggest that some variation in treatment could be a function of what type of professionals are available to treat the child. However, Currie and Cuddy (2020) find that relatively little of the variation in treatment across areas can be explained by counts of different types of local providers.…”

Section: B Supply-side Variation In Access To Mental Health Treatmentmentioning

confidence: 84%

“…For example, shortages of child psychiatrists are an important factor limiting treatment in many areas (Thomas and Holzer, 2006;McBain et al, 2019;Findling and Stepanova, 2008). However, Cuddy and Currie (2020) show that several supply side factors of this kind collectively explain little of the overall variation in treatment probabilities across areas. Hence, they may prove to be weak potential instruments.…”

Section: Introductionmentioning

confidence: 94%

Rules vs. Discretion: Treatment of Mental Illness in U.S. Adolescents

Cuddy¹,

Currie²

2020

Self Cite

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Mental health disorders are a leading cause of disability worldwide. Many mental health disorders start in adolescence and appropriate treatment at the outset may improve trajectories. We use a large national data base of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next two years. We find that receiving follow up mental health treatment in the first three months after an initial mental health claim increases the total cost of care over the next 24 months. These higher costs are entirely accounted for by children who receive treatment that is not consistent with practice guidelines. Our estimates imply that, within 24 months, children who initially received a red-flag drug have 205% higher costs than those of the average treated child and are 131% more likely to have used an emergency room or experienced a hospitalization. These results show that large numbers of U.S. children are receiving mental health care that falls outside of accepted guidelines and poses risks to their health. In doing so, they provide support for the guidelines themselves, and demonstrate that analyses of large-scale claims data can provide a useful complement to clinical research studies in identifying best practices.

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“…Medication use was determined using outpatient drug claims grouped by the IBM Micromedex ® RED BOOK ™ therapeutic class indicating antidepressant, anxiolytics, mood stabilizers, and antipsychotics [ 21 ]. Prescriptions for any benzodiazepine and any tricyclic antidepressant were also explored.…”

Section: Methodsmentioning

confidence: 99%

Healthcare use in commercially insured youth with mental health disorders

Hugunin

Davis

Larkin

et al. 2022

BMC Health Serv Res

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Background The objective of this study is to describe age-related patterns of outpatient healthcare utilization in youth and young adults with mental health disorders. Method We used the IBM® MarketScan® Commercial Database to identify 359,413 youth and young adults (12–27 years) with a mental health disorder continuously enrolled in private health insurance in 2018. Exploratory analysis was used to describe patterns of outpatient healthcare use (e.g., primary, reproductive, mental health care) and therapeutic management (e.g., medication prescriptions, psychotherapy) by age. Period prevalence and median number of visits are reported. Additional analysis explored utilization patterns by mental health disorder. Results The prevalence of outpatient mental health care and primary care decreased with age, with a larger drop in primary care utilization. While 74.0-78.4% of those aged 12–17 years used both outpatient mental health care and primary care, 53.1–59.7% of those aged 18–27 years did. Most 18–19-year-olds had a visit with an internal medicine or family medicine specialist, a minority had a pediatrician visit. The prevalence of medication management increased with age, while the prevalence of psychotherapy decreased. Conclusions Taken together, this descriptive study illustrates age-related differences in outpatient healthcare utilization among those with mental health disorders. Additionally, those with the most severe mental health disorders seem to be least connected to outpatient care. This knowledge can inform efforts to improve utilization of healthcare across the transition to adulthood.

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Treatment of mental illness in American adolescents varies widely within and across areas

Cited by 23 publications

References 26 publications

Mental Health Surveillance Among Children — United States, 2013–2019

Mental Health Surveillance Among Children — United States, 2013–2019

Rules vs. Discretion: Treatment of Mental Illness in U.S. Adolescents

Healthcare use in commercially insured youth with mental health disorders

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