Adolescents’ internalizing mental health problems, related care causing new treatment demands, study suggests

Ramin Mojtabai

The growing number of adolescents receiving care for internalizing mental health problems and the increasing share receiving care in specialty outpatient settings have put new demands on specialty adolescent mental health treatment centers, according to results of a survey study published in JAMA Psychiatry.

“The mental health care system needs to adapt to these changes in the profiles of adolescent psychopathology,” Ramin Mojtabai, MD, PhD, MPH, of the department of mental health at Johns Hopkins Bloomberg School of Public Health, told Healio Psychiatry. “Providers working with adolescents in various settings are increasingly dealing with patients who are presenting with internalizing problems such as depression, anxiety and suicidal ideations. Not all providers and settings have the resources needed to deal with these types of problems.”

As an example of these challenges, Mojtabai referenced shortages among school counseling services staff, which increases demands on their time. Although researchers have identified recent national trends in the prevalence of internalizing and externalizing problems for service delivery, few studies have explored the implications of these trends. Specifically, research is sparse regarding recent changes in the clinical distribution of adolescent mental health care provided by specialty mental health, general medical and school services.

Mojtabai and colleagues aimed to examine national trends in the care of different mental health problems and in different treatment settings among adolescents. They collected data from the National Survey on Drug Use and Health — an annual cross-sectional survey of the general U.S. population. Specifically, they analyzed data of 230,070 adolescents aged 12 years to 17 years interviewed from January 2005 to December 2018. The researchers examined time trends in 12-month prevalence of any mental health treatment in various settings overall and for different sociodemographic groups, treatment settings (general medical, school counseling, inpatient mental health and outpatient mental health) and types of mental health problems (internalizing, externalizing, school related and relationship). They also examined trends of nights in inpatient settings and number of visits.

Of the adolescents analyzed, 47,090 (19.7%) received mental health care across survey years. Most (57.5%) were female, 31.3% were aged 12 to 13 years, 35.8% were aged 14 to 15 years and 32.9% were aged 16 to 17 years. Over time, the overall prevalence of mental health care did not change appreciably. However, mental health care increased among three groups:

• girls, 22.8% from 2005 to 2006 to 25.4% from 2017 to 2018 (adjusted OR [aOR] = 1.11; 95% CI, 1.04-1.19);

• non-Hispanic white adolescents, 20.4% from 2005 to 2006 to 22.7% from 2017 to 2018 (aOR = 1.08; 95% CI, 1.03-1.14); and

• those with private insurance, 19.4% from 2005 to 2006 to 21.2% from 2017 to 2018 (aOR = 1.11; 95% CI, 1.04-1.18).

Externalizing problems (31.9% from 2005 to 2006 to 23.7% from 2017 to 2018; aOR = 0.67; 95% CI, 0.62-0.73) and relationship problems (30.4% from 2005 to 2006 to 26.9% from 2017 to 2018; aOR = 0.75; 95% CI, 0.69-0.82) accounted for decreasing proportions of care, whereas internalizing problems, such as depressive symptoms and suicidal ideation, accounted for an increasing proportion (48.3% from 2005 to 2006 to 57.8% from 2017 to 2018; aOR = 1.52; 95% CI, 1.39-1.66). Moreover, use of outpatient mental health services increased during this period, from 58.1% from 2005 to 2006 to 67.3% from 2017 to 2018 (aOR = 1.47; 95% CI, 1.35-1.59); however, use of school counseling decreased from 49.1% in 2005 to 2006 to 45.4% in 2017 to 2018 (aOR = 0.86; 95% CI, 0.79-0.93). The researchers reported increases in outpatient mental health visits, such as to private mental health clinicians, from 7.2 from 2005 to 2006 to nine from 2017 to 2018 (incidence rate ratio [IRR] = 1.3; 95% CI, 1.23-1.37) and overnight stays in inpatient mental health settings, from four nights from 2005 to 2006 to 5.4 nights in 2017 to 2018 (IRR = 1.18; 95% CI, 1.02-1.37).

“Adequate management of some of these mental health problems requires collaboration across various settings, especially school counseling services and specialty mental health services — the two most commonly used types of services by adolescents,” Mojtabai told Healio Psychiatry. – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.