Treatment of mental illness in American adolescents varies widely within and across areas

Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episod...

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Published inProceedings of the National Academy of Sciences - PNAS Vol. 117; no. 39; pp. 24039 - 24046
Main Authors Cuddy, Emily, Currie, Janet
Format Journal Article
LanguageEnglish
Published United States National Academy of Sciences 29.09.2020
SeriesFrom the Cover
Subjects
Adolescent
Adolescents
Aftercare - statistics & numerical data
Antidepressants
Benzodiazepines
Child
Children
Female
Guideline Adherence - statistics & numerical data
Health services
Healthcare Disparities
Humans
Illnesses
Inappropriate Prescribing - statistics & numerical data
INAUGURAL ARTICLE
Male
Medical personnel
Medical treatment
Mental disorders
Mental Disorders - therapy
Mental health
Mental health care
Psychology, Adolescent
Psychotropic Drugs - therapeutic use
Social Sciences
Tricyclic antidepressants
Variation
treatment
adolescent
mental health
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Summary:Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes. We also found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: Overall, in the first 3 mo after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age. On average, these children are 12 y old. While the supply of mental health professionals impacts treatment choices, little of the overall variation is explained by supply-side variables, and at least half of the variation in treatment outcomes occurs within zip codes. These results suggest that other factors, such as physician practice style, may play an important role in the types of treatment that children receive.
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Contributed by Janet Currie, August 6, 2020 (sent for review April 20, 2020; reviewed by Jay Bhattacharya, Jonathan Gruber, and Jonathan Skinner)
Author contributions: E.C. and J.C. designed research; E.C. and J.C. performed research; E.C. and J.C. analyzed data; and J.C. wrote the paper.
Reviewers: J.B., Stanford University; J.G., Massachusetts Institute of Technology; and J.S., Dartmouth College.
This contribution is part of the special series of Inaugural Articles by members of the National Academy of Sciences elected in 2019.
ISSN:0027-8424
1091-6490
DOI:10.1073/pnas.2007484117