Use of mental health services in transition age youth with bipolar disorder.
OBJECTIVE
There is concern that treatment of serious mental illness in the United States declines precipitously following legal emancipation at age 18 years and transition from specialty youth clinical settings. We examined age transition effects on treatment utilization in a sample of youth with bipolar disorder.


METHODS
Youth with bipolar disorder (N=413) 7-18 years of age were assessed approximately twice per year (mean interval 8.2 months) for at least 4 years. Annual use of any individual, group, and family therapy, psychopharmacology visits, and hospitalization at each year of age, and monthly use from ages 17 through 19 years, were examined. The effect of age transition to 18 years on monthly visit probability was tested in the subsample with observed transitions (n=204). Putative sociodemographic moderators and the influence of clinical course were assessed.


RESULTS
Visit probabilities for the most common modalities-psychopharmacology, individual psychotherapy, and home-based care- generally fell from childhood to young adulthood. For example, the annual probability of at least one psychopharmacology visit was 97% at age 8, 75% at age 17, 60% at age 19, and 46% by age 22. Treatment probabilities fell in transitionage youth from age 17 through 19, but a specific transition effect at age 18 was not found. Declines did not vary based on sociodemographic characteristics and were not explained by changing severity of the bipolar illness or functioning.


CONCLUSIONS
Mental health treatment declined with age in this sample of youth with bipolar disorder, but reductions were not concentrated during or after the transition to age 18 years. Declines were unrelated to symptom severity or impairment.
HOWER, YEN, and WEINSTOCK: Brown University and Butler Hospital, Providence, RI; CASE and HUNT: Brown University, and Emma Pendleton Bradley Hospital, East Providence, RI; HOEPPNER: Massachusetts General Hospital and Harvard Medical School, Cambridge, MA; T. GOLDSTEIN, BIRMAHER, RYAN, and GILL: Western Psychiatric Institute and Clinic and University of Pittsburgh Medical Center, Pittsburgh, PA; B. GOLDSTEIN: Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Center, University of Toronto, Canada; TOPOR: VA Boston Healthcare System and Harvard Medical School; STROBER: University of California, Los Angeles; AXELSON: Nationwide Children's Hospital, Columbus, OH; KELLER: Butler Hospital. For disclosures and acknowledgments see page 474.
Heather
H
Hower
Brady G
BG
Case
Bettina
B
Hoeppner
Shirley
S
Yen
Tina
T
Goldstein
Benjamin
B
Goldstein
Boris
B
Birmaher
Lauren
L
Weinstock
David
D
Topor
Jeffrey
J
Hunt
Michael
M
Strober
Neal
N
Ryan
David
D
Axelson
Mary
M
Kay Gill
Martin B
MB
Keller
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001714:Bipolar Disorder / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult