Use of outpatient mental health services by depressed and anxious children as they grow up.
OBJECTIVE
Childhood-onset psychiatric disorders can be persistent and impairing but often go untreated. Affected individuals' treatment utilization into adulthood is not well understood. A 15-year follow-up of depressed, anxious, and never mentally ill children (control group) examined need, predisposing, and enabling factors associated with use of outpatient mental health care into early adulthood.


METHODS
Between 1977 and 1985, a total of 315 children and adolescents were ascertained. Their psychiatric status and treatment utilization into adulthood were reassessed between 1991 and 1997 by clinicians blind to their childhood diagnoses.


RESULTS
Respondents ascertained for depression demonstrated 13-fold, and those ascertained for anxiety demonstrated six-fold, greater odds of any treatment compared with controls. Among utilizers, childhood depression conferred 14-fold, and childhood anxiety, 23-fold, increased odds of long-term treatment. Blacks were less likely than whites to obtain treatment. Utilizers older at follow-up reported longer treatment duration. Mood disorder episodes over follow-up and poorer global functioning were associated with both increased odds of any utilization and increased treatment duration among utilizers.


CONCLUSIONS
This sample demonstrated high and persistent treatment utilization. Need indicated by childhood diagnosis was the strongest predictor of treatment; however, utilization also differed by race or ethnicity. Strategies to maximize the uptake of effective, culturally relevant treatment approaches should be investigated.
Goldstein
Risë B
RB
Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Room 3068, Mail Stop 9304, Bethesda, Maryland 20892, USA. goldster@mail.nih.gov
Olfson
Mark
M
Wickramaratne
Priya J
PJ
Wolk
Susan I
SI
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D002648:Child; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009518:New York; D010552:Personality Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D014600:Utilization Review / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D001741:Black or African American