Factors associated with mental health service utilization among bipolar youth.
OBJECTIVE
This study aims to characterize patterns of mental health service utilization within a sample of bipolar youth. Demographic variables, youth bipolar characteristics, youth comorbid conditions, and parental psychopathology were examined as predictors of treatment utilization across different levels of care.


METHODS
A total of 293 bipolar youth (aged 7-17 years) and their parents completed a diagnostic interview, family psychiatric history measures, and an assessment of mental health service utilization. Demographic and clinical variables were measured at baseline and mental health service use was measured at the six-month follow-up.


RESULTS
Approximately 80% of bipolar youth attended psychosocial treatment services over the span of 6 months. Of those who attended treatment, 67% attended only outpatient services, 22% received inpatient/partial hospitalization, and 12% received residential/therapeutic school-based services. Using multinomial logistic regression, older age, female gender, and bipolar characteristics, including greater symptom severity and rapid cycling, were found to predict higher levels of care. Youth suicidal and non-suicidal self-injurious behavior, comorbid conduct disorder, and parental substance use disorders also predicted use of more restrictive treatment settings.


CONCLUSIONS
Results underscore the importance of assessing for and addressing suicidality, comorbid conduct disorder, and parental substance use disorders early in the treatment of bipolar youth to potentially reduce the need for more restrictive levels of care.
Rizzo
Christie J
CJ
Department of Psychiatry and Human Behavior, Brown Medical School, CAAS, Box G-BH, Providence, RI 02912, USA. christie_rizzo@brown.edu
Esposito-Smythers
Christianne
C
Swenson
Lance
L
Birmaher
Boris
B
Ryan
Neal
N
Strober
Michael
M
Chiappetta
Laurel
L
Valeri
Sylvia
S
Hunt
Jeffrey
J
Axelson
David
D
Leonard
Henrietta
H
Keller
Martin
M
D000293:Adolescent; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008483:Medical Assistance / Q000458:organization & administration; D016347:Medical Records Systems, Computerized; D008605:Mental Health Services / Q000458:organization & administration*; D010290:Parents / Q000523:psychology; D010372:Pediatrics; D011787:Quality of Health Care