Mental Healthcare
Utilization as Adolescents
Become Young Adults
Jennifer W. Yu, Sc.D.
Sally H. Adams, Ph.D.
Claire Brindis, Dr.P.H.
Charles E. Irwin, Jr., M.D.
University of California, San Francisco
AcademyHealth Annual Meeting
June 27, 2006
Background
• Young adults (ages 18 to mid-20’s) constitute
a unique population with regards to mental
health
• Mental health problems in adolescence not
only persist into young adulthood, but may
become exacerbated if left untreated earlier
in life
– Mortality due to suicide is almost three times
greater among young adults than adolescents
(CDC, 2005)
Background
• There is a paucity of literature on mental healthcare
for young adults
• Children and adolescents have high rates of unmet
mental health needs, despite existing support
systems
• Young adults face numerous barriers to accessing
appropriate medical care
– Gaps in insurance coverage (Callahan & Cooper, 2005)
– The transitional nature of young adulthood makes it difficult
to establish appropriate support systems (Park, et al., in
press)
Research Objectives
• Compare rates of mental health service
(MHS) utilization between adolescents and
young adults
• Determine predictors of MHS use for young
adults
• Identify reasons for foregone care among
those with mental health needs in young
adulthood
The National Longitudinal Study of
Adolescent Health (Add Health)
(n=10,817)
132 schools across the US, stratified
by size, school type, census region,
level of urbanization, percent white
1995 Wave 1
1996 Wave 2
2001 Wave 3
N = 20,745
Ages 12-19
N = 14,738
Ages 13-21
N = 12,000
Ages 18-26
Objective 1: Rates of MHS use during
Adolescence and Young Adulthood
(n=10,817)
Total Population
*p<0.001
Adolescent
%
Young Adult
%
Difference
%
11.5
6.9
4.6*
Objective 1: Rates of MHS use during
Adolescence and Young Adulthood
Total Population
Adolescent
%
Young Adult
%
Difference
%
(n)
(n)
11.5
6.9
4.6*
6.3*
Mental Health Subgroups
Mild to Severe
Depressive Symptoms1
21.4
15.1
(2761)
(2176)
Suicidal ideation
23.9
22.5
(1020)
(481)
40.3
40.6
(257)
(100)
41.7
37.9
(147)
(65)
Suicide attempt
Suicide multiple attempts
*p<0.001
1 Measured by the CES-D scale
1.4
-0.3
3.8
Objective 2
• Determine predictors of MHS use for young
adults
• Methods
– Logistic regression analysis of sociodemographic,
adolescent (Wave 1), and young adult (Wave 3)
variables predicting MHS utilization in young
adulthood
• Dependent Variable
– 747 (6.9%) participants received MHS during
young adulthood
Predictors of MHS use in
Young Adulthood
Characteristics
Multivariate
Odds Ratio
95% CI
Black
0.57
(1.10-1.77)
Current school attendance
1.48
(1.05-2.09)
Routine physical exam
1.58
(1.16-2.15)
Female
1.71
(1.23-2.37)
Maternal ed: highest
2.17
(1.21-3.88)
Mental health problems
3.62
(2.58-5.07)
Objective 3
• Identify reasons for foregone care among those with
mental health needs in young adulthood
• Foregone Care: Was there a time in the past 12
months when you should have received care, but did
not receive it?
– Mental Health Need (n=402)
• Had a problem related to severe stress, depression, or
nervousness
– Other Health Need (n=2,122)
• E.g. Injury during a physical fight, felt sick or had symptoms of
a health problem
Add Health Items:
Reasons for Foregone Care
• Access Problems
– E.g., Couldn’t pay, No transportation, Didn’t
know whom to see
• Non-Access Problems
– E.g., Thought the problem would go away,
Too embarrassed, Didn’t think the doctor
could help
Foregone Care: Access Reasons
Couldn't pay
*
Difficult to m ake
appt
Didn't know
w hom to see
No
transportation
Mental Health Needs
Other Health Needs
No one w as
available
0
5
10
15
20
25
30
35
40
45
*p<0.01
Foregone Care: Non-Access Reasons
Problem w ill go
aw ay
No tim e
Afraid of w hat
MD says/does
*
MD cannot help
*
Mental Health Needs
Don't w ant
parents to know
Other Health Needs
Too
em barrassed
0
5
10
15
20
25
30
35
40
*p<0.01
Summary
• Young adults reported lower rates of MHS
use compared to adolescents
• Significant sociodemographic variables
– Female gender and high maternal education
increased MHS use
– Black race decreased MHS use in young
adulthood
• Significant young adult (Wave 3) variables
– Attending school, receiving routine physical
exams, and experiencing mental health problems
Summary
• Both young adults with mental and other
healthcare needs identify similar reasons for
foregone care
• However, young adults who forego mental
healthcare cited inability to pay and concerns
regarding physician’s care significantly more
often than those who forego other healthcare
Conclusions
• Unmet mental health needs continue to exist in
young adulthood, particularly among individuals with
depressive symptomology.
• Blacks and males as specific populations that are
less likely to utilize MHS.
• Health insurance does not play a role in MHS
utilization, perhaps because many health plans do
not provide significant MH coverage.
• Physicians’ awareness of their role can help promote
MHS use in young adults.
Acknowledgements
•
Agency for Healthcare Research and Quality (5 T32 HS000086)
•
Maternal and Child Health Bureau, Health Resources and Services
Administration, U.S. Department of Health and Human Services
(U45MC 00023).
•
This research uses data from Add Health, a program project designed
by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and
funded by a grant P01-HD31921 from the National Institute of Child
Health and Human Development, with cooperative funding from 17
other agencies. Special acknowledgment is due Ronald R. Rindfuss
and Barbara Entwisle for assistance in the original design. Persons
interested in obtaining data files from Add Health should contact Add
Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill,
NC 27516-2524 (addhealth@unc.edu).