title: Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A).
abstract: OBJECTIVE
  Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement.
  
  
  METHODS
  Face-to-face survey of mental disorders from 2002 to 2004 using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents 13 to 18 years old for whom information on service use was available from an adolescent and a parent report. Total and sector-specific mental health service use was also assessed.
  
  
  RESULTS
  Approximately one third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest in those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but fewer than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly in youth with behavior disorders. Hispanic and non-Hispanic Black adolescents were less likely than their White counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment.
  
  
  CONCLUSIONS
  Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.
authors.affiliation: Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, Bethesda, MD 20892, USA. kathleen.merikangas@nih.gov
authors.forename: Kathleen Ries
authors.initials: KR
authors.lastname: Merikangas
authors.forename: Jian-ping
authors.initials: JP
authors.lastname: He
authors.forename: Marcy
authors.initials: M
authors.lastname: Burstein
authors.forename: Joel
authors.initials: J
authors.lastname: Swendsen
authors.forename: Shelli
authors.initials: S
authors.lastname: Avenevoli
authors.forename: Brady
authors.initials: B
authors.lastname: Case
authors.forename: Katholiki
authors.initials: K
authors.lastname: Georgiades
authors.forename: Leanne
authors.initials: L
authors.lastname: Heaton
authors.forename: Sonja
authors.initials: S
authors.lastname: Swanson
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
mesh_terms: D000293:Adolescent; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006301:Health Services Needs and Demand; D006306:Health Surveys; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007406:Interview, Psychological; D008134:Long-Term Care / Q000523:psychology / Q000706:statistics & numerical data*; D016743:Mental Competency; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States