Mental Health Service Use and Youth Reported Reasons for Treatment, 2009-2018

​Larson K, Gottschlich E, Tang SF

Accepted for 2020 Pediatric Academic Societies Annual Meeting

Background: Suicide rates, depression, and other mental health problems are on the rise for adolescents. Prior studies have not examined how the pattern of youths' own reported reasons for receiving mental health treatment may have changed over time.

Objective: Examine trends in mental health service use for US youth, and among those receiving services, change in youth reported reasons for receiving treatment.

Methods: Mental health service use is examined among a sample of 156,490 youth ages 12-17 from the 2009-2018 National Survey on Drug Use and Health. Adolescents were asked if they received treatment/counseling in the past year for an emotional/behavioral problem from two sources: specialty mental health provider (private therapist, psychiatrist, psychologist, social worker, day treatment/residential care) or school counselor/therapist. They also reported the reason(s) for their most recent treatment in each setting from a list of 12, which we categorized as internalizing, externalizing, or other/neutral (Table). Subsamples of youth receiving specialty mental health and school counselor/therapist services in 2009 and 2018 are used to examine change in the percent of youth reporting specific reasons for treatment. Statistical significance of change between 2009 and 2018 is determined from 95% confidence intervals.

Results: The percent of youth reporting receipt of specialty mental health services increased from 12 to 16% between 2009 and 2018 (p<.05, Figure), representing an estimated increase from 3.0 to 3.9 million youth in the total US population. Receipt of treatment from a school counselor/therapist stayed constant at nearly 10%. Youth reported reasons for receiving treatment showed steep increases in internalizing problems (Table). Among youth receiving specialty mental health services, the percent reporting depression as at least one reason for treatment increased from 46 to 57% from 2009-2018, suicidal thoughts/actions from 21 to 32%, and afraid/tense from 20 to 30%, all p<.05. A similar pattern is apparent for youth reported reasons for seeing a school counselor: depression (35-45%), suicidal thoughts/actions (10-17%), and feeling afraid/tense (17-27%), all p<.05. Externalizing problems like breaking rules, fighting, and anger problems significantly declined as youth reported reasons for receiving one or both types of treatment.

Conclusion: Youth reported using more mental health services for depression, anxiety, and suicide. This reflects national trends showing increases in youth suicide and diagnoses of depression.