Mental Healthcare Utilization as Adolescents

Become Young AdultsJennifer W. Yu, Sc.D.Sally H. Adams, Ph.D.Claire Brindis, Dr.P.H.

Charles E. Irwin, Jr., M.D.University of California, San Francisco

AcademyHealth Annual MeetingJune 27, 2006

Background

• Young adults (ages 18 to mid-20’s) constitute a unique population with regards to mental health

• Mental health problems in adolescence not only persist into young adulthood, but may become exacerbated if left untreated earlier in life– Mortality due to suicide is almost three times

greater among young adults than adolescents (CDC, 2005)

Background

• There is a paucity of literature on mental healthcare for young adults

• Children and adolescents have high rates of unmet mental health needs, despite existing support systems

• Young adults face numerous barriers to accessing appropriate medical care– Gaps in insurance coverage (Callahan & Cooper, 2005)– The transitional nature of young adulthood makes it difficult

to establish appropriate support systems (Park, et al., in press)

Research ObjectivesResearch Objectives

• Compare rates of mental health service (MHS) utilization between adolescents and young adults

• Determine predictors of MHS use for young adults

• Identify reasons for foregone care among those with mental health needs in young adulthood

The National Longitudinal Study of The National Longitudinal Study of Adolescent Health (Add Health)Adolescent Health (Add Health)

132 schools across the US, stratified by size, school type, census region, level of urbanization, percent white

1995 Wave 1

N = 20,745Ages 12-19

1996 Wave 2

N = 14,738Ages 13-21

2001 Wave 3

N = 12,000Ages 18-26

(n=10,817)(n=10,817)

Objective 1: Rates of MHS use during Adolescence and Young Adulthood

(n=10,817)Adolescent

%Young Adult

%Difference

%

Total Population 11.5 6.9 4.6*

*p<0.001

Objective 1: Rates of MHS use during Adolescence and Young Adulthood

Adolescent%(n)

Young Adult%(n)

Difference%

Total Population 11.5 6.9 4.6*

Mental Health Subgroups

Mild to Severe Depressive Symptoms1

21.4 (2761)

15.1 (2176)

6.3*

Suicidal ideation 23.9(1020)

22.5(481)

1.4

Suicide attempt 40.3 (257)

40.6 (100)

-0.3

Suicide multiple attempts 41.7 (147)

37.9 (65)

3.8

*p<0.0011 Measured by the CES-D scale

Objective 2

• Determine predictors of MHS use for young adults

• Methods– Logistic regression analysis of sociodemographic,

adolescent (Wave 1), and young adult (Wave 3) variables predicting MHS utilization in young adulthood

• Dependent Variable– 747 (6.9%) participants received MHS during

young adulthood

Predictors of MHS use in Young Adulthood

Characteristics Multivariate

Odds Ratio

95% CI

Black 0.57 (1.10-1.77)

Current school attendance 1.48 (1.05-2.09)

Routine physical exam 1.58 (1.16-2.15)

Female 1.71 (1.23-2.37)

Maternal ed: highest 2.17 (1.21-3.88)

Mental health problems 3.62 (2.58-5.07)

Objective 3

• Identify reasons for foregone care among those with mental health needs in young adulthood

• Foregone Care: Was there a time in the past 12 months when you should have received care, but did not receive it?– Mental Health Need (n=402)

• Had a problem related to severe stress, depression, or nervousness

– Other Health Need (n=2,122)• E.g. Injury during a physical fight, felt sick or had symptoms of a

health problem

Add Health Items: Reasons for Foregone Care

• Access Problems– E.g., Couldn’t pay, No transportation, Didn’t

know whom to see

• Non-Access Problems– E.g., Thought the problem would go away,

Too embarrassed, Didn’t think the doctor could help

Foregone Care: Access Reasons

0 5 10 15 20 25 30 35 40 45

No one wasavailable

Notransportation

Didn't knowwhom to see

Difficult to makeappt

Couldn't pay

Mental Health Needs

Other Health Needs

*

*p<0.01

Foregone Care: Non-Access Reasons

0 5 10 15 20 25 30 35 40

Tooembarrassed

Don't wantparents to know

MD cannot help

Afraid of whatMD says/does

No time

Problem will goaway

Mental Health Needs

Other Health Needs

*

*

*p<0.01

Summary

• Young adults reported lower rates of MHS use compared to adolescents

• Significant sociodemographic variables– Female gender and high maternal education

increased MHS use– Black race decreased MHS use in young

adulthood

• Significant young adult (Wave 3) variables– Attending school, receiving routine physical

exams, and experiencing mental health problems

Summary

• Both young adults with mental and other healthcare needs identify similar reasons for foregone care

• However, young adults who forego mental healthcare cited inability to pay and concerns regarding physician’s care significantly more often than those who forego other healthcare

Conclusions

• Unmet mental health needs continue to exist in young adulthood, particularly among individuals with depressive symptomology.

• Blacks and males as specific populations that are less likely to utilize MHS.

• Health insurance does not play a role in MHS utilization, perhaps because many health plans do not provide significant MH coverage.

• Physicians’ awareness of their role can help promote MHS use in young adults.

Acknowledgements

• Agency for Healthcare Research and Quality (5 T32 HS000086)

• Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services (U45MC 00023).

• This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (addhealth@unc.edu).