Children’s Use of Psychiatric Services on the Rise, NEJM Article Finds
A new study using data from AHRQ’s Medical Expenditure Panel Survey (MEPS) found that the percentage of children 6 to 17 years old receiving outpatient mental health service increased from 9.2 percent in 1996–1998 to 13.3 percent in 2010–2012. Youths with less severe or no impairment accounted for a significant amount of the increase. Researchers calculated that 4.19 million youths with less severe or no mental health impairment used mental health services in 2010–2012, up from 2.74 million in 1996–1998. The number of youths with severe impairment who received services, meanwhile, increased from about 1.6 million to 2.34 million in the same time period. Fewer than half of youths with severe impairment, however, accessed mental care services in 2010–2012, researchers found. The study, led by Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and the New York State Psychiatric Institute, used data from the 1996–1998, 2003–2005 and 2010–2012 MEPS to examine trends in outpatient use of mental health services among 53,622 children 6 to 17 years old. The study and abstract were published in the May 20 edition of the New England Journal of Medicine.
Trends in Mental Health Care among Children and Adolescents
N Engl J Med 2015; 372:2029-2038May 21, 2015DOI: 10.1056/NEJMsa1413512
BACKGROUNDIncreasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment.
METHODSWe analyzed the 1996–1998, 2003–2005, and 2010–2012 Medical Expenditure Panel Surveys, which were nationally representative surveys of U.S. households, for trends in outpatient use of mental health services by persons 6 to 17 years of age; 53,622 persons were included in the analysis. Mental health impairment was measured with the use of the Columbia Impairment Scale (range, 0 to 52, with higher scores indicating more severe impairment); we classified youths with scores of 16 or higher as having more severe impairment and those with scores of less than 16 as having less severe impairment.
RESULTSThe percentage of youths receiving any outpatient mental health service increased from 9.2% in 1996–1998 to 13.3% in 2010–2012 (odds ratio, 1.52; 95% confidence interval, 1.35 to 1.72). The proportionate increase in the use of mental health services among youths with more severe impairment (from 26.2% to 43.9%) was larger than that among youths with less severe or no impairment (from 6.7% to 9.6%). However, the absolute increase in annual service use was larger among youths with less severe or no impairment (from 2.74 million to 4.19 million) than among those with more severe impairment (from 1.56 million to 2.28 million). Significant overall increases occurred in the use of psychotherapy (from 4.2% to 6.0%) and psychotropic medications (from 5.5% to 8.9%), including stimulants and related medications (from 4.0% to 6.6%), antidepressants (from 1.5% to 2.6%), and antipsychotic drugs (from 0.2% to 1.2%).
CONCLUSIONSOutpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996–1998 and 2010–2012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet fewer than half accessed services in 2010–2012. (Funded by the Agency for Healthcare Research and Quality and the New York State Psychiatric Institute.)
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