Special Article
Trends in Mental Health Care among Children and Adolescents
N Engl J Med 2015; 372:2029-2038May 21, 2015DOI: 10.1056/NEJMsa1413512
Background
Increasing 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.
Methods
We 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.
Results
The 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%).
Conclusions
Outpatient 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.)
Supported by a grant (U19 HS021112) from the Agency for Healthcare Research and Quality and by the New York State Psychiatric Institute.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Source Information
From the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute — both in New York (M.O.); the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (B.G.D.); and the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the School of Social Practice and Policy, University of Pennsylvania — both in Philadelphia (S.C.M.).
Address reprint requests to Dr. Olfson at the New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Dr., New York, NY 10032, or at mo49@cumc.columbia.edu.
Media in This Article
Trends in the Use of Psychotropic Medications.
Trends in the Percentage of Young People with More Severe Mental Health Impairment.
