title: Health insurance and treatment of adolescents with co-occurring major depression and substance use disorders.
abstract: OBJECTIVE
  The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders.
  
  
  METHODS
  Seven years of cross-sectional data (2004-2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables.
  
  
  RESULTS
  Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone.
  
  
  CONCLUSIONS
  Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.
authors: Emory University Rollins School of Public Health. ldicola@alum.emory.edu
authors: Laura A
authors: LA
authors: Dicola
authors: Laura M
authors: LM
authors: Gaydos
authors: Benjamin G
authors: BG
authors: Druss
authors: Janet R
authors: JR
authors: Cummings
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D013287:Illicit Drugs; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data*; D008297:Male; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*
chemical_list: D013287:Illicit Drugs
keywords: adolescents; co-occurring disorders; depression treatment; health insurance; substance use treatment