Roughly 1 in 5 U.S. adolescents received mental health care between 2005 and 2018, with the greatest proportion receiving care for internalizing mental health conditions such as depression and suicidal ideation, a study in JAMA Psychiatry has found.
“Trends in types of problems for which adolescents received care correspond with recent national trends of adolescent psychopathology and appear to highlight the growing importance of recognizing and managing internalizing problems across the major treatment settings,” wrote Ramin Mojtabai, M.D., Ph.D., M.P.H., of Johns Hopkins Bloomberg School of Public Health and Mark Olfson, M.D., M.P.H., of Columbia University.
Mojtabai and Olfson examined data from 230,070 adolescents aged 12 to 17 years who were interviewed as part of the National Survey on Drug Use and Health from January 1, 2005, through December 31, 2018. The survey participants were asked whether they had received mental health treatment or counseling in the past 12 months, where they received this care, and the reasons for receiving care. Internalizing problems included thoughts of killing or harming themselves, depressive symptoms, feeling afraid or tense, or eating problems. Externalizing problems included breaking rules, trouble controlling anger, or getting into fights. Relationship problems included problems at home, in the participant’s family, or with the participant’s friends.
The researchers found that 47,090 adolescents, or 19.7% of the total sample, reported receiving mental health care during the past year. Of those who received care, 51.8% received care for internalizing problems, 29.7% for externalizing problems, 29.7% for relationship problems, and 18.4% for school-related problems, with some reporting care for more than one kind of problem.
The proportion who received care for internalizing problems increased from 48.3% in 2005-2006 to 57.8% in 2017-2018. This increase was notable for suicidal thoughts or suicide attempts, which rose from 15.0% of those who received mental health care in 2005-2006 to 24.5% in 2017-2018. The proportion of adolescents who received care for externalizing problems declined from 31.9% in 2005-2006 to 23.7% in 2017-2018. The proportion receiving care for relationship problems declined from 30.4% in 2005-2006 to 26.9% in 2017-2018.
The majority of adolescents (61.5%) received care in outpatient mental health settings, followed by counseling in schools (48.8%), general medical settings (14.5%), and inpatient mental health settings (12.3%).
“The observed trends in adolescent mental health care raise questions about the extent to which these problems are matched to appropriate services,” Mojtabai and Olfson wrote. “School counseling and general medical services may not be optimally equipped to manage more severe forms of internalizing problems that account for a large and increasing share of the adolescent mental health problems they encounter.”
For related information, see the Psychiatric Services article “Differences in Utilization of Mental Health Treatment Among Children and Adolescents With Medicaid or Private Insurance.”
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