National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians

Olfson, Mark; Blanco, Carlos; Wang, Shual; Laje, Gonzalo; Correli, Christoph U.
January 2014
JAMA Psychiatry;Jan2014, Vol. 71 Issue 1, p81
Academic Journal
IMPORTANCE Despite evidence of the increasing use of psychotropic medications, little is known about the broader changes in the delivery of outpatient mental health treatment to children, adolescents, and adults. OBJECTIVE To assess national trends and patterns in the mental health care of children, adolescents, and adults in office-based medical practice. DESIGN, SETTING, AND PARTICIPANTS Outpatient visits to physicians in office-based practice from the 1995-2010 National Ambulatory Medical Care Surveys (N = 446 542). Trends (1995-2010) in visits with mental health care indicators are first compared between youths (<21 years) and adults (>21 years) and then between children (0-13 years) and adolescents (14-20 years). Background and clinical characteristics of recent visits (2007-2010) resulting in a mental disorder diagnosis are also compared among children, adolescents, and adults. MAIN OUTCOMES AND MEASURES Visits resulting in mental disorder diagnoses, prescription of psychotropic medications, provision of psychotherapy, or psychiatrist care. RESULTS Between 1995-1998 and 2007-2010, visits resulting in mental disorder diagnoses per 100 population increased significantly faster for youths (from 7.78 to 15.30 visits) than for adults (from 23.23 to 28.48 visits) (interaction; P < .001). Psychiatrist visits also increased significantly faster for youths (from 2.86 to 5.71 visits) than for adults (from 10.22 to 10.87 visits) (interaction: P < .001). Psychotropic medication visits increased at comparable rates for youths (from 8.35 to 17.12 visits) and adults (from 30.76 to 65.90 visits) (interaction: P = .13). While psychotherapy visits increased from 2.25 to 3.17 per 100 population for youths, they decreased from 8.37 to 6.36 for adults (interaction; P < .001). In 2007-2010, 27.4% of child visits, 47.9% of adolescent visits, and 36.6% of adult visits resulting in a mental disorder diagnosis were to a psychiatrist. CONCLUSIONS AND RELEVANCE Compared with adult mental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use. A great majority of mental health care in office-based medical practice to children, adolescents, and adults is provided by nonpsychiatrist physicians calling for increased consultation and communication between specialties.


Related Articles

  • Caregiver Participation in Community-Based Mental Health Services for Children Receiving Outpatient Care. Fawley-King, Kya; Haine-Schlagel, Rachel; Trask, Emily; Zhang, Jinjin; Garland, Ann // Journal of Behavioral Health Services & Research;Apr2013, Vol. 40 Issue 2, p180 

    Caregiver participation in child mental health treatment has been associated with better youth outcomes, but little is known about the amount and type of caregiver participation in usual care services for children. This study examined 1,255 caregivers' reports of their participation in the...

  • Trends in Subthreshold Psychiatric Diagnoses for Youth in Community Treatment. Safer, Daniel J.; Rajakannan, Thiyagu; Burcu, Mehmet; Zito, Julie M. // JAMA Psychiatry;Jan2015, Vol. 72 Issue 1, p75 

    IMPORTANCE: Patterns and trends of subthreshold DSM-IV mental health diagnoses for youth within US community treatment settings merit systematic research. OBJECTIVE: To quantify and assess temporal patterns of DSM-IV diagnoses not otherwise specified (NOS) among youth during physician office...

  • Vorsorgeuntersuchungen und Screenings bei jungen Menschen. Pfennig, A.; Klosterkötter, J. // Der Nervenarzt;Dec2014, Vol. 85 Issue 12, p1544 

    Background: Severe mental illnesses become manifested early in life. First episodes are suffered in young adulthood at the latest and early symptoms and signs are often already reported in childhood and adolescence. Therefore, it is exactly these adolescents and young adults who have to be...

  • Listening to Bickman: Findings from Child Mental Health Services Research. McLennan, John D. // Journal of the Canadian Academy of Child & Adolescent Psychiatry;Winter2015, Vol. 24 Issue 1, p59 

    The article focuses on child mental health services. Topics discussed include the expansion of psychotropic medication for children and adolescents, the guide for contemporary service reform recommended for child mental health, and the importance of care model services and the use of...

  • The Need for Caution in Diagnosing and Treating Mental Disorders. FRANCES, ALLEN; RAVEN, MELISSA // American Family Physician;10/15/2013, Vol. 88 Issue 8, p490C 

    The authors comment on the diagnosis and treatment of mental disorders by nonpsychiatrists. They discuss the impact of the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic tool on family physicians in specialized mental health services....

  • EXPANDING THE BASE FOR CHILD MENTAL HEALTH SERVICE AND TRAINING. Feiner, Joel S.; Tarnow, Jay D. // Journal of Special Education;Spring77, Vol. 11 Issue 1, p49 

    A mental health role and professional training situation was developed, spanning the child-related systems of school, pediatric, and mental health clinics. The physician intern's work in the natural setting of the school had three facets, each related to a systems intervention framework. (a)...

  • User satisfaction with child and adolescent mental health services. Bjårngaard, Johan; Andersson, Helle Wessel; Ose, Solveig Osborg; Hanssen-Bauer, Ketil // Social Psychiatry & Psychiatric Epidemiology;Aug2008, Vol. 43 Issue 8, p635 

    Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. The study was undertaken...

  • Focus on psychiatry in Hungary. Tringer, László // British Journal of Psychiatry;Jan99, Vol. 174, p81 

    The article describes the state of psychiatry in Hungary. It focuses on the important achievements and emphasize that Hungarian psychiatry developed as an organic part of European scientific life. It describes the structure of psychiatric institutions of Hungary, and the most problem in the...

  • outside the box.  // Mental Health Today;Feb2006, p19 

    Discusses the findings of a study which examined the diagnosis of psychiatric disorders in children in the U.S. Prevalence of psychiatric illness in children; Characteristics of children with suspected attention deficit disorder; Need to improve access to mental health services.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics