A longitudinal study of adolescent mental health service use

Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study

BACKGROUND

Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality.

OBJECTIVE

Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context.

METHODS

We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke's reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention.

RESULTS

A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person's post and emojis to further conversations and build rapport.

CONCLUSIONS

The findings highlight the importance of the counselor's role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person's experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively.

Treatment Rates for Mental Disorders Among Children and Adolescents: A Systematic Review and Meta-Analysis

Importance

Mental disorders among children and adolescents are global health concerns. Published studies have provided discordant results regarding treatment rates for mental disorders among youths.

Objective

To estimate combined treatment rates for several common psychiatric disorders among children and adolescents.

Data Sources

PubMed, Web of Science, PsycINFO, Scopus, and Embase were searched from database inception until September 23, 2022, and supplemented with hand-searching of reference lists.

Study Selection

Included studies were those that used validated methods to report treatment rates for any mental disorder, depressive disorders, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and behavior disorders among children and adolescents.

Data Extraction and Synthesis

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two reviewers independently assessed study eligibility, extracted data, and scored quality. Studies with a Joanna Briggs Institute score of 5 or more were included in the meta-analysis. Treatment rates were pooled using random-effects models. Subgroup analyses were performed to investigate the association with treatment rates of factors, such as year of data collection, World Health Organization region, age, income level, timeframe of diagnosis, informant source, service type, sample origin, and internalizing or externalizing disorder.

Main Outcomes and Measures

Treatment rates for mental disorders among children and adolescents were the main outcomes, measured as percentage estimates.

Results

Forty studies were included in the analysis, comprising 310 584 children and adolescents, with boys accounting for 39% of participants (sex was not reported in 10 studies). The pooled treatment rate was 38% (95% CI, 30%-45%) for any mental disorder, 36% (95% CI, 29%-43%) for depressive disorders, 31% (95% CI, 21%-42%) for anxiety disorders, 58% (95% CI, 42%-73%) for ADHD, and 49% (95% CI, 35%-64%) for behavior disorders. Age, income level, and region were significantly associated with the combined treatment rates of mental disorders in children and adolescents. The treatment rate for depressive disorders was higher among adolescents than children (36% [95% CI, 25%-46%] vs 11% [95% CI, 0%-25%]), whereas the treatment rate for anxiety disorders was higher among children than adolescents (64% [95% CI, 52%-75%] vs 20% [95% CI, 9%-30%]). The treatment rate for any mental disorder in lower-middle income countries was 6% (95% CI, 2%-14%), in upper-middle income countries was 24% (95% CI, 2%-47%), and in high-income countries was 43% (95% CI, 35%-52%). For depressive disorders, treatment rates were higher in the Americas (40% [95% CI, 30%-51%]) than in Europe (28% [95% CI, 13%-43%]) and the Western Pacific region (6% [95% CI, 1%-16%]).

Conclusions and Relevance

This study suggests that, in general, the treatment rates for mental disorders among children and adolescents were low, especially for depression and anxiety. Targeted intervention policies and effective measures should be designed and implemented to improve treatment rates of psychiatric disorders among youths.

Identifying Social Determinants and Measuring Socioeconomic Inequalities in the Use of Four Different Mental Health Services by Australian Adolescents Aged 13-17 Years: Results from a Nationwide Study

AIM

In this study, we aimed to identify the determinants of four different forms of mental health service usage (general health services, school counselling, telephone, and online services), and the number of mental health services accessed (single and multiple) by Australian adolescents aged 13-17 years. We also measured socioeconomic inequality in mental health services' usage following the concentration index approach within the same sample.

SUBJECT AND METHODS

The data came from the nationwide cross-sectional survey, Young Minds Matter (YMM): the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Random effect models were used to identify the factors associated with four different mental health services and the number of services accessed. Further, the Erreygers' corrected concentration indices for binary variables were used to quantify the socioeconomic inequality in each mental health service. The four services were the general health service (GP, specialist, psychiatrist, psychologist, hospital including emergency), school services, telephone counselling and online services.

RESULTS

Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion statistically significantly increased the use of general health and multiple mental health service usage (p < 0.05). Area of residence was also found to be a significant factor for online service use. The concentration indices (CIs) were -0.073 (p < 0.001) and -0.032 (p < 0.001) for health and telephone services, respectively, which implies pro-rich socio-economic inequality.

CONCLUSION

Adolescents from low-income families frequently used general mental health services and telephone services compared to those who belonged to high-income families. The study concluded that if we want to increase adolescents' usage of mental health services, we need to tailor our approaches to their socioeconomic backgrounds. In addition, from a policy standpoint, a multi-sectoral strategy is needed to address the factors related to mental health services to reduce inequity in service utilisation.

Systematic Review of Gender-Specific Child and Adolescent Mental Health Care

Gender differences in mental health emerge as early as in childhood and adolescence, highlighting the potential need for gender-specific child and adolescent mental health care. However, it is unclear how gender-specific child and adolescent mental health care is implemented and whether its' approaches are useful. Therefore, this study reviews gender-specific interventions and their effectiveness for child and adolescent mental health. Five databases were searched for articles published between 2000 and 2021. In total, 43 studies were included. Most interventions were conducted in school (n = 15) or community settings (n = 8). Substance-related disorders (n = 13) and eating disorders (n = 12) were addressed most frequently. Most interventions targeted girls (n = 31). Various gender-specific aspects were considered, including gender-specific risk and protective factors (n = 35) and needs (n = 35). Although most interventions yielded significant improvements in mental health outcomes (n = 32), only few studies reported medium or large effect sizes (n = 13). Additionally, there was a lack of strong causal evidence derived from randomized controlled trials, calling for more rigorous trials in the research field. Nevertheless, our findings indicate that gender-specific mental health care can be a promising approach to meet gender-specific mental health needs.

Social experiences with mental health service use among US adolescents

BACKGROUND

Little is known about the associations of social experiences with mental health service use.

AIM

This study aimed to classify social experiences variables in the past year and examine the associations of selected variables in social experiences with mental health service use among US adolescents.

METHODS

A total of 13,038 adolescents (aged 12 to 17), of which 2208 received mental health services, were from the 2018 National Survey on Drug Use and Health. Multivariate logistic regression (MLR) analysis was conducted.

RESULTS

The overall prevalence of mental health service use was 16.1%. 44 variables on social experiences were grouped into 10 disjoint clusters and one variable from each cluster was selected for MLR analysis. Being female, African American, Hispanics, insured and having depression in the past year were associated with increased odds of mental health service use. Negative feelings about going to school, having a serious fight at school/work, active involvement in substance use help programs, knowledge of drug prevention, negative perceptions about the role of religious beliefs on life decisions were positively associated with mental health service use.

CONCLUSION

Mental health service use is associated with feelings about school and peers, perceptions about drug use, and involvement in activities.

The effect of public health insurance expansions on the mental and behavioral health of girls and boys

This paper examines the effects of public health insurance expansions on the mental health care utilization and mental and behavioral health of children 6-17 years old. We leverage major expansions in public health insurance eligibility for children and adolescents under Medicaid and the State Children's Health Insurance Program during 1997-2002 to examine mental health care utilization and outcomes for children in the National Survey of America's Families. The study examines these dynamics by gender of children due to their distinct mental health care patterns and risks. The expansions are associated with an estimated 30% reduction in mental health care utilization for girls, but no measurable effect for boys, which may partly be accounted for by increased well-child visits for girls. Mental health improves only for teenagers; boys in particular have an estimated 22 percent increase in their probability of the highest level of health. Parents experience spillovers of lower insurance coverage for themselves - likely from dropping private family coverage for public child-only coverage - but slightly better mental health.

Age and sex specific incidence for depression from early childhood to adolescence: A 13-year longitudinal analysis of German health insurance data

BACKGROUND

Epidemiological studies indicate a disproportionate increase of depression incidence among adolescent girls, compared with boys. Since results regarding the age of onset of this sex difference are heterogeneous, this study aimed to investigate this difference on a large and representative sample. A second investigation sought to clarify whether there is a relevant sex difference in prepubertal onset of depression regarding the further course.

METHODS

Health insurance data of 6-18-year-old Barmer insured patients, representing a 7.9% sample of the German population born in 1999 (N = 61.199), were analyzed. The incidence of depression episodes (ICD-10 F32.x) was evaluated. Subsequently, the absolute and relative risk of a depression diagnosis (F32.x/F33.x) in early/late adolescence was analyzed based on the diagnosis of depression in primary school age in unstratified and stratified univariate analyses performed in SAS.

RESULTS

From 13 years of age, we found a significantly higher incidence of depressive disorders in girls than in boys. More than a fifth of the children with a depression diagnoses in primary school age had a depression relapse in early or late adolescence (early: 23.2%; 95% CI 19.6-26.9/late: 22.9%; 95% CI 19.3-26.5). Boys with depression in primary school age have a significantly higher relative risk for a depression relapse in late adolescence than girls (boys RR 4.2, 95% CI 3.3-5.2, girls RR: 2.1, 95% CI 1.7-2.7).

LIMITATIONS

The analysis is based on administrative data. Low sensitivity for depression in primary care setting and low service utilization leads to an underestimation of the incidence.

CONCLUSIONS

During puberty the risk for a first depressive episode increases more steeply in girls than in boys. Childhood depression has a high risk of relapse for both sexes, but is much more pronounced for boys.

The Main and Interactive Associations between Demographic Factors and Psychopathology and Treatment Utilization in Youth: A Test of Intersectionality in the ABCD Study

Demographic factors may be associated with youth psychopathology due to social-contextual factors that may also pose barriers to intervention. Further, in line with intersectionality theory, youth with multiple non-dominant identities may be most likely to experience psychopathology and face barriers to care. This study examined rates of parent-reported psychopathology and mental health treatment utilization as a function of several demographic characteristics (in isolation and in concert) in a population-based, demographically diverse sample of 11,875 9- to 10-year-old youth. Results indicated most consistently that lower SES was associated with greater rates of psychopathology and greater likelihood of treatment utilization; that Asian American youth (relative to all other racial groups) and Hispanic/Latinx (relative to non-Hispanic/Latinx) youth were less likely to have a history of psychopathology or to have utilized treatment; and that male youth had greater rates of lifetime Obsessive Compulsive Disorder (OCD) and Oppositional Defiant Disorder (ODD) and were more likely to have utilized treatment. There was more modest support for interactive effects between demographic factors on psychopathology, which are discussed. The present study provides some support for differential rates of parent-reported psychopathology and treatment utilization as a function of demographic identities in youth. Potential explanations for these differences (e.g., cultural differences in symptom presentation; underreporting of symptoms) are discussed.

The use of mental health services by Australian adolescents with mental disorders and suicidality: Findings from a nationwide cross-sectional survey

OBJECTIVES

Mental disorders and suicidality among adolescents have been identified as a major public health concern worldwide; however, they often do not get the necessary attention from parents, school and health professional, and therefore are left untreated. This study aimed to investigate the factors associated with the use of mental health services among Australian adolescents aged 13-17 with mental disorders and/or suicidality.

METHODS

Adolescents aged 13-17 (n = 2134) from Young Minds Matter (YMM): the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing were included in this study. The YMM is a cross-sectional nationwide survey, in which information was collected from both parents and adolescents (aged 13-17 years). Both bivariate and multivariate analyses were conducted to identify the factors that have an impact on the use of mental health services (outcome variable) in two subsamples: (1) adolescents with mental disorder and (2) adolescents with suicidality.

RESULTS

Overall, 740 (34.7%) and 168 (7.9%) adolescents reported a mental disorder and/or suicidality, respectively. The incidence of seeking any service was higher among adolescents with suicidality (approximately 50%) compared to those with a mental disorder (about 30%). Girls, older age-group (15-17), adolescents living with disadvantaged families (lower-income, less educated and unemployed parents), those who had multiple mental disorders and history of substance use were most likely to use mental health services regardless of mental disorder and suicidality. Health services and online services were the most popular type of mental health service among adolescents aged 13-17 across two subgroups, while, school and telephone services were less utilized.

CONCLUSIONS

Many adolescents with mental disorders and/or suicidality do not use mental health services. The findings indicate differences in factors associated with the use of mental health services among adolescents with mental disorder and suicidality. Further research is needed to address the specific barriers that limit the use of the services.

Enrolment of children and adolescents in psychosocial care: more likely with low family social support and poor parenting skills

Knowledge about determinants of child and adolescent enrolment in psychosocial care concerns only single types of care and usually only socio-demographic factors. The social environment is also a likely key determinant but evidence is lacking. The aim of this study was to examine the associations between family social support, parenting skills and child and adolescent enrolment in psychosocial care. We obtained data on 1,331 children (response rate 56.6%), 4-18 years old, enrolled in preventive child health care, and child and adolescent social care and mental health care because of psychosocial problems, and on 463 children (response rate 70.3%) not enrolled in psychosocial care. Results showed that enrolment in psychosocial care was associated with low family social support (odds ratio; 95%-confidence interval: 3.2; 2.4-4.4), and with poor parenting skills, i.e. poor supervision (1.5; 1.1-2.1) and inconsistent disciplining (1.5; 1.1-2.1). Children's psychosocial problems partially mediated the associations with family social support and completely with parenting skills. Children's problems did not moderate the associations. Positive parenting was not associated with care enrolment. We conclude that low family social support and poor parenting are important factors associated with enrolment, in particular because they are associated with more frequent occurrence of children's psychosocial problems. This implies that professionals and policymakers need to be aware that factors in children's social environment are related with enrolment in psychosocial care, in addition to children's psychosocial problems.

The Impact of Continued Contact with Biological Parents upon the Mental Health of Children in Foster Care

This study examined depression and externalizing problems of children in foster care using a subsample of data (N = 362) from the National Survey of Child and Adolescent Well-Being. Our findings indicated that more frequent contact with the biological mother was marginally associated with lower levels depression and significantly associated with lower externalizing problem behaviors. The association with externalizing problem behavior was significant even after controlling for gender and exposure to violence. Further, differences with regard to gender were revealed. Specifically, girls had higher depression scores than boys even after controlling for exposure to violence. Results suggest that supporting frequent, consistent, visitation may impact the levels of depression and externalizing programs children in foster care exhibit.

Costs associated with attention deficit hyperactivity disorder: overview and future projections

The costs associated with attention deficit hyperactivity disorder are considerable. These costs are incurred for the provision of health services, out-of-pocket family expenditures, educational services and juvenile justice services. In this review, we present the components of these costs and discuss factors likely to make a significant impact. It is shown that pharmaceuticals and ambulatory care services, in particular outpatient mental healthcare, account for the majority of healthcare costs. Finally, data are presented that suggest attention deficit hyperactivity disorder is associated with increased educational costs, while increased costs associated with juvenile justice may be due to mental health comorbidity. We speculate on future costs for attention deficit hyperactivity disorder given the introduction of new pharmaceutical agents and discuss projected increases in the prevalence of the disorder in under-represented populations.

Factors associated with use of mental health services for depressed and/or suicidal youth aged 15-24

Using data from a national survey, this study examined different factors and their association with mental health service use in youth aged 15-24 with depression and/or suicidality. Our sample consisted of 1,252 youth with depression and/or suicidality. In youth aged 15-18 years old, two factors influenced service use: (1) co-occurrence of depression and suicidality (OR 3.23, 95% CI 1.43, 7.32) and (2) chronic health condition (OR 2.44, 95% CI 1.22, 4.84). Several factors were associated with service use in youth aged 19-24 including gender (female) (OR 1.77, 95% CI 1.14, 2.76), and low income (OR 1.89, 95% CI 1.11, 3.23). The findings suggest differences in the factors associated with mental health service use between youth aged 15-18 and 19-24 with depression and/or suicidality.

Pediatric to adult mental health service use of young people leaving the foster care system

PURPOSE

To assess and predict changes in mental health service use as older youth leave the foster care system.

METHODS

Participants were 325 19-year-olds participating in a longitudinal study of older youth leaving the foster care system in Missouri. All were in the foster care system at age 17. Participants were interviewed nine times between their 17th and 19th birthdays using the Service Assessment for Children and Adolescents and a history calendar to improve recall of service history. Analyses included Cox proportional hazards regression to predict time to service stoppage and McNemar's test to assess difference in rates of service use between age 17 and 19.

RESULTS

Mental health service use dropped dramatically across the study period for all services. Service rates dropped most steeply for youth who left the foster care system. Service use rates declined by roughly 60% from the month prior to leaving the foster care system to the month after leaving the system. Most young adults who stopped pharmacotherapy following discharge from foster care reported they did so of their own volition.

CONCLUSIONS

Practitioners should be aware of the possibility of patient-initiated mental health service discontinuation following exit from the foster care system and plan accordingly.

Perceived norms and mental health help seeking among African American college students

In general, African Americans do not seek mental health treatment from formal sources at the same rates as Caucasians. The present study examined whether culturally relevant factors (i.e., perceived negative peer and family norms about help seeking) influence help-seeking intentions in a late adolescent African-American sample (n = 219) and whether there is a gender difference in the predictive strength between peer and family norms. Participants were primarily female (n = 144). Multiple regressions were implemented to explore the relationship between perceived norms and help-seeking intentions. Analyses revealed that males had higher perceived peer norms, and family norms were a stronger predictor of intentions than peer norms for females. Individually, peer norms and family norms were related to help-seeking intentions. When perceived norms were analyzed together, only negative family norms were related to intentions. Findings suggest that incorporating family norms is critical when developing interventions to increase formal service utilization among African Americans.

Adult and peer involvement in help-seeking for depression in adolescent population: a two-year follow-up in Finland

Help-seeking among adolescents and adults is often perceived as a process involving only the health care system and the individual suffering from psychiatric symptoms. The present study attempted to create a model of help-seeking also including members of adolescents social networks. A prospective follow-up design included a school-based survey on all ninth grade students (mean age 15.5) during the academic year 2002-2003 in two Finnish towns (N = 3,278; response rate 94%); and a follow-up conducted two years later (N = 2,080; response rate 63%). The respondents were assessed for current depression and help-seeking for depression and other mental health problems each time. In the follow-up they were asked if they felt that they need help for depression and if their mother, father, sibling, peers, boy- or girl-friend or teacher had been worried about changes in their mood or behaviour. The associations of perceived need for help, help-seeking behaviour and concerns of different people, with depression at baseline were studied. Stepwise logistic regression models were computed to find the best predictors for help-seeking for depression. One third of the adolescents meeting R-BDI-13 criteria for depression at baseline still perceived a need for help for depression two years later but only a fifth of them had sought professional help. Depression at baseline was significantly associated with concerns about changes in mental health or behaviour among parents and significant others; and the concerns of mother, peers and teacher were among the best predictors of recent help-seeking for depression. To ensure adequate intervention for depressed adolescents without a social network capable of prompting referral, routine screening for depression should be applied in primary health care services and specialized services for adolescents.

Unmet Mental Health Service Needs Among Norwegian Children and Adolescents

BACKGROUND

  The Norwegian 10 year mental health plan identifies important roles for public health nurses in the early identification, care and referral of children and adolescents with mental health problems. This study aims to identify the extent to which public health nurses are meeting these needs.

METHOD

  Over a 4 week period the mental health needs of 3065 children who were seen by publich health nurses were identified.

RESULTS

  Achieving the ongoing Norwegian mental health plan may require better access to trained professionals in the public health sector, further expansion of specialised mental health services, and efforts to improve inter-agency collaboration.

Racial disparities in mental health service use by adolescents who thought about or attempted suicide

Differences in rates and predictors of mental health service use among 2,226 Black, Hispanic, and White adolescents (aged 12-17) who reported recent suicidal thoughts or an attempt were examined. Black adolescents were 65% (OR = .65, p < .05), and Hispanic adolescents were 55% (OR = .55, p < .001), as likely as White adolescents to report service use, even when controlling for need for care and ability to secure services. Suicide attempt and psychiatric symptoms each interacted with race to increase the odds of service use uniquely for White adolescents. Results indicate that racial disparities characterize adolescents' mental health service use even when suicide risk increases.

Gender disparities in mental health service use of Puerto Rican children and adolescents

BACKGROUND

Differences in service utilization indicating that boys use more mental health services than girls were analyzed to see if they could be explained by known correlates of service use. These correlates were arranged into individual (severe emotional disturbance, level of impairment and externalizing disorders), family (parental education, psychopathology and parental concern) and school factors (difficulties with school work). The objectives were to understand and identify the factors accounting for gender differences in mental health service utilization in order to develop alternatives to promote equity in service delivery.

METHODS

A representative sample of 1,896 children 4 to 17 years of age and their primary caretakers were interviewed for this study. Reports of service use were obtained using the Service Assessment for Children and Adolescents. Logistic regression was used to assess the relationship between gender and service use, adjusting for known correlates.

RESULTS

Our results showed that, except for impairment, other individual, family and school factors did not explain gender differences in service utilization. Males with impairment were 2.87 times more likely to receive services than impaired females (p <or= .01), and this result continued to hold true for impaired undiagnosed boys compared to impaired diagnoses-free girls (p <or= .001).

CONCLUSIONS

Our findings showed a service disparity between impaired boys and girls who did not meet criteria for a DSM IV diagnosis, but no observed differences in service use between boys and girls who met criteria for severe emotional disturbance (SED). Continued investigations are necessary to analyze, assess and understand the different circumstances that bring boys and girls into treatment, followed by the development of appropriate intervention programs at the school and community levels.

The premature demise of public child and adolescent inpatient psychiatric beds : Part II: challenges and implications

Psychiatric disorders are the leading reason for hospitalization among 5-19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services "fit" into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population.

Effects of alcohol and drug use on inpatient and residential treatment among youth with severe emotional disturbance in Medicaid-funded behavioral health care plans

This study examined the use of alcohol and recreational drugs among 875 youth with severe emotional disturbance (SED) enrolled in Medicaid-funded behavioral health care plans, and whether co-occurring SED and substance use affected the subsequent likelihood of receiving inpatient and/or residential treatment. Youth at five sites nationwide were interviewed about their use of drugs and alcohol, while interviews with their caregivers elicited information about youths' service utilization, degree of functional impairment, and a series of demographic and environmental variables. Results indicated that half of the youth (52%) reported lifetime use of alcohol, street drugs, or over-the-counter medications for recreational purposes, while 18% reported use in the past 30 days. Among those reporting recent use, 32% reported using drugs only, 34% alcohol only, and 33% reported use of both drugs and alcohol. In multivariate logistic regression analyses, the effect of recent use was stronger than that of lifetime use; however, the largest effect occurred for those reporting recent use of both drugs and alcohol, versus either alone, or none. Differences remained significant when controlling for managed care versus fee for service enrollment as well as child, family, and environmental characteristics including study site. These results mirror those of prior studies that found an association between substance use and greater likelihood of inpatient services, even in managed care settings.

Gender differences in the association between substance use and elevated depressive symptoms in a general adolescent population

AIMS

This study explores gender differences in the association between substance use and elevated depressive symptoms in the general adolescent population.

DESIGN

Cross-sectional self-reported anonymous survey, the 2002/2003 Student Drug Use Survey in the Atlantic Provinces. The sample design was a single-stage cluster sample of randomly selected classes stratified by grade and region.

SETTING

The four Atlantic provinces of Canada.

PARTICIPANTS

A total of 12 771 students in junior and senior high schools of the public school systems, representing a response rate of about 97%. The average age of participants was 15.2 years.

MEASUREMENTS

The measure of elevated depressive symptoms was a 12-item version of the CES-D with three categories of depression risk validated in a companion study.

FINDINGS

The prevalence of very elevated depressive symptoms was 8.6% in females and 2.6% in males. Alcohol use and cigarette smoking were found to be independent predictors of elevated depressive symptoms in females, but not males; cannabis use was found to be an independent predictor of elevated depressive symptoms in both males and females. Age was found to have a curvilinear relationship with elevated depressive symptoms in females but not in males. The adolescent's academic performance and province of residence were found to be independent risk factors of elevated depressive symptoms among both males and females. About 10.3% of adolescents considered to be potential candidates for needing help reported having received help because they felt depressed.

CONCLUSIONS

The association between depression risk and age, alcohol use, cigarette smoking and cannabis use in the general adolescent population is not straightforward and may differ according to gender. There is unmet need for help for depression among adolescents.

Gender differences in patterns of risk factors among children receiving mental health services: latent class analyses

Latent class analyses were used to analyze data from a sample of children participating in the national evaluation of the Comprehensive Communities Mental Health Services for Children and Their Families Program (N = 6786). Lifetime risk experiences of the child were analyzed to identify 4 classes of boys and girls with similar risk patterns. While low-risk, status-offense, abuse, and high-risk classes were identified for both boys and girls, there were nearly half the number of girls in the low-risk class, almost as many in the status-offense class, twice as many in the abuse class, and more than 3 three times as many in the high-risk class as there were boys. These findings suggest that there are specific groups of children entering services who differ as a function of their lifetime risk exposure. In addition, the relationship between class membership and child functioning, and class membership and family lifetime risk experiences. Understanding these differences provides critical information to the service planning process. In addition, it may result in immediate improvement in the triage of children into services and a better understanding of their behaviors during and after treatment.

Non-adherence to antipsychotic medication regimens: associations with resource use and costs

BACKGROUND

Several factors are thought to influence resource use and costs in treating schizophrenia.

AIMS

To assess the relative impact of non-adherence and other factors associated with resource use and costs incurred by people with schizophrenia.

METHOD

Secondary analyses were made of data from a 1994 national survey of psychiatric morbidity among adults living in institutions in the UK. Factors potentially relating to resource use and costs were examined using two-part models.

RESULTS

Patients who failed to adhere to their medication regimen were over one-and-a-half times as likely as patients who did adhere to it to report use of in-patient services. Non-adherence is one of the most significant factors in increasing external service costs, by a factor of almost 3. Non-adherence predicted an excess annual cost per patient of approximately 2500 British pounds for in-patient services and over 5000 British pounds for total service use.

CONCLUSIONS

Resource use and costs are influenced by various factors. Medication non-adherence consistently exhibits an association with higher costs. Further important factors are patient needs and the ability of the system to address them.

Receipt of psychological or emotional counseling by suicidal adolescents

OBJECTIVE

This study examined utilization of psychological or emotional counseling by suicidal adolescents to answer questions about the extent to which health services can contribute to the prevention of adolescent suicide.

METHOD

The study used data from Wave 1 of the National Longitudinal Study of Adolescent Health, which involved a household-based interview with a nationally representative sample of 15 483 adolescents from grades 7 to 12. Of these, 2482 adolescents were classified as suicidal, as indicated by an affirmative response to the question "During the past 12 months, did you ever seriously think about committing suicide?" For this group, the study asked the following questions: 1) What proportion receives psychological or emotional counseling? 2) What are the sources of this counseling? 3) What factors are associated with receipt of such counseling?

RESULTS

Less than one third (28%) of suicidal adolescents received psychological or emotional counseling. The most common sources of care were private doctors' offices (37%) and schools (34%). Factors associated with receipt of counseling in the past 12 months included age, race, degree of suicidality, depression status, and having had a physical examination during the same period.

CONCLUSIONS

Only one third of those who report suicidal ideation and behavior receive psychological or emotional counseling. Although not all of these young people may identify a need for counseling, this finding still suggests that many of those at risk of harming themselves do not receive professional help. However, on the positive side, those who do use counseling services tend to do so on the basis of their being in the greatest need, rather than their parents' capacity to pay for services. Counseling services have an important role to play in suicide prevention, and a variety of sources of care need to be available. Although counseling services are vital, a range of other strategies is necessary to reduce the youth suicide rate.