CoChat
Sign Up
Cited by 229Mental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional DevelopmentAdolescent and Pediatric Healthcare

National trends in mental health care for US adolescents

Open access
Mojtabai, Ramin, Olfson, Mark·2020·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2020.0279PMC PMC7097842
Open this paper in CoChat — free accountOpen PDF

Abstract

Importance: The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined. Objective: To examine national trends in the care of different mental health problems and in different treatment settings among adolescents. Design, Setting, and Participants: Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019. Main Outcomes and Measures: Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined. Results: A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased. Conclusions and Relevance: This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2020.0279

Cites

13 of 13 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Given increasing incidence of mental health problems and help-seeking among adolescents, group therapy may be a cost-effective alternative to individual therapy.

    “Given the increasing incidence of mental health problems and help-seeking among adolescents (Mojtabai and Olfson, 2020; Thapar et al., 2022), group therapy may be a cost-effective alternative to individual therapy (Bjerke et al., 2021).”

    From “And I Can Remind Myself That I Am All Of This”: adolescents’ experiences of group-based acceptance and commitment therapy (2024) · cites this paper as Mojtabai and Olfson, 2020

    The Abstract and Discussion describe rising prevalence of depression and other internalizing problems, and the Service Settings and Trends in Care section reports increased use of outpatient mental health services. But the Overall Trend in Care section says the proportion of adolescents receiving any mental health care was stable from 2005 to 2018; the paper therefore does not support a general increase in help-seeking or establish increasing incidence of mental health problems. The cost-effectiveness comparison is attributed to Bjerke et al., not to this source. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The prevalence of emotional disorders (e.g., anxiety and depression) is increasing among adolescents.

    “research indicates that the prevalence of emotional disorders (e.g., anxiety and depression) is increasing among adolescents (Mojtabai and Olfson, 2020; Vizard et al., 2020; Bakken, 2022; Thapar et al., 2022).”

    From “And I Can Remind Myself That I Am All Of This”: adolescents’ experiences of group-based acceptance and commitment therapy (2024) · cites this paper as Mojtabai and Olfson, 2020

  • There are indications of increased use of specialist mental health services in adolescents.

    “There are also indications of increased use of specialist mental health services in this age group (Mojtabai and Olfson, 2020).”

    From “And I Can Remind Myself That I Am All Of This”: adolescents’ experiences of group-based acceptance and commitment therapy (2024) · cites this paper as Mojtabai and Olfson, 2020

  • The demand for youth mental health care has increased, and workforce and skills shortages are a major challenge globally, particularly in low-resource settings.

    “The demand for youth mental health care has increased, 230,380-382 and workforce and skills shortages are a major challenge globally, particularly in low-resource settings.”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [382]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 45

  1. Achenbach TM, Ivanova MY, Rescorla LA, Turner LV, Althoff RR. Internalizing/externalizing problems: review and recommendations for clinical and research applications. J Am Acad Child Adolesc Psychiatry. 2016;55(8):647-656. doi:10.1016/j.jaac. 2016.05.012 · DOI
  2. Zahn-Waxler C, Klimes-Dougan B, Slattery MJ. Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression. Dev Psychopathol. 2000;12(3):443-466. doi:10.1017/S0954579400003102 · DOI
  3. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance: United States, 2017. MMWR Surveill Summ. 2018;67(8):1-114. doi:10.15585/ mmwr.ss6708a1 · DOI · Paper page
  4. Grucza RA, Krueger RF, Agrawal A, et al. Declines in prevalence of adolescent substance use disorders and delinquent behaviors in the USA: a unitary trend? Psychol Med. 2018;48(9):1494-1503. doi:10.1017/S0033291717002999 · DOI
  5. Patrick ME, Terry-McElrath YM, Miech RA, Schulenberg JE, O'Malley PM, Johnston LD. Age-specific prevalence of binge and high-intensity drinking among US young adults: changes from 2005 to 2015. Alcohol Clin Exp Res. 2017;41(7):1319- 1328. doi:10.1111/acer.13413 · DOI
  6. Terry-McElrath YM, O'Malley PM, Johnston LD, Bray BC, Patrick ME, Schulenberg JE. Longitudinal patterns of marijuana use across ages 18-50 in a US national sample: a descriptive examination of predictors and health correlates of repeated measures latent class membership. Drug Alcohol Depend. 2017;171:70-83. doi:10.1016/j.drugalcdep. 2016.11.021 · DOI
  7. Fergusson DM, Lynskey MT, Horwood LJ. Origins of comorbidity between conduct and affective disorders. J Am Acad Child Adolesc Psychiatry. 1996;35(4):451-460. doi:10.1097/00004583- 199604000-00011 · DOI
  8. Wolff JC, Ollendick TH. The comorbidity of conduct problems and depression in childhood and adolescence. Clin Child Fam Psychol Rev. 2006;9 (3-4):201-220. doi:10.1007/s10567-006-0011-3 · DOI
  9. Achenbach TM, Dumenci L, Rescorla LA. Are American children's problems still getting worse? a 23-year comparison. J Abnorm Child Psychol. 2003; 31(1):1-11. doi:10.1023/A:1021700430364 · DOI
  10. Lilienfeld SO. Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions. J Abnorm Child Psychol. 2003;31(3):285-291. doi:10.1023/A:1023229529866 · DOI
  11. Agrawal A, Tillman R, Grucza RA, et al. Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism. J Affect Disord. 2017;213:96-104. doi: 10.1016/j.jad.2016.12.060 · DOI
  12. Lee EJ, Bukowski WM. Co-development of internalizing and externalizing problem behaviors: causal direction and common vulnerability. J Adolesc. 2012;35(3):713-729. doi:10.1016/j.adolescence.2011. 10.008 · DOI
  13. Boylan K, Vaillancourt T, Boyle M, Szatmari P. Comorbidity of internalizing disorders in children with oppositional defiant disorder. Eur Child Adolesc Psychiatry. 2007;16(8):484-494. doi:10.1007/ s00787-007-0624-1 · DOI
  14. Harpaz-Rotem I, Rosenheck RA. Changes in outpatient psychiatric diagnosis in privately insured children and adolescents from 1995 to 2000. Child Psychiatry Hum Dev. 2004;34(4):329-340. doi:10.1023/B:CHUD.0000020683.08514.2d · DOI
  15. Olfson M, Blanco C, Wang S, Laje G, Correll CU. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. 2014;71(1):81-90. doi: 10.1001/jamapsychiatry.2013.3074 · DOI · Paper page
  16. Ali MM, West K, Teich JL, Lynch S, Mutter R, Dubenitz J. Utilization of mental health services in educational setting by adolescents in the United States. J Sch Health. 2019;89(5):393-401. doi:10.1111/josh.12753 · DOI
  17. American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys, 8th edition. Revised April 2015. Accessed February 18, 2020. https://www.aapor.org/AAPOR_Main/media/ MainSiteFiles/Standard-Definitions2015_8thEd.pdf
  18. Mitchell KS, Wolf EJ, Reardon AF, Miller MW. Association of eating disorder symptoms with internalizing and externalizing dimensions of psychopathology among men and women. Int J Eat Disord. 2014;47(8):860-869. doi:10.1002/eat.22300 · DOI
  19. Collishaw S, Maughan B, Goodman R, Pickles A. Time trends in adolescent mental health. J Child Psychol Psychiatry. 2004;45(8):1350-1362. doi:10.1111/j.1469-7610.2004.00335.x · DOI · Paper page
  20. Fleming TM, Clark T, Denny S, et al. Stability and change in the mental health of New Zealand secondary school students 2007-2012: results from the National Adolescent Health Surveys. Aust N Z J Psychiatry. 2014;48(5):472-480. doi:10.1177/ 0004867413514489 · DOI
  21. Sigfusdottir ID, Asgeirsdottir BB, Sigurdsson JF, Gudjonsson GH. Trends in depressive symptoms, anxiety symptoms and visits to healthcare specialists: a national study among Icelandic adolescents. Scand J Public Health. 2008;36(4): 361-368. doi:10.1177/1403494807088457 · DOI · Paper page
  22. Tick NT, van der Ende J, Verhulst FC. Twenty-year trends in emotional and behavioral problems in Dutch children in a changing society. Acta Psychiatr Scand. 2007;116(6):473-482. doi:10.1111/j.1600-0447.2007.01068.x · DOI
  23. Tick NT, van der Ende J, Verhulst FC. Ten-year trends in self-reported emotional and behavioral problems of Dutch adolescents. Soc Psychiatry Psychiatr Epidemiol. 2008;43(5):349-355. doi:10.1007/s00127-008-0315-3 · DOI
  24. von Soest T, Wichstrøm L. Secular trends in depressive symptoms among Norwegian adolescents from 1992 to 2010. J Abnorm Child Psychol. 2014;42(3):403-415. doi:10.1007/s10802- 013-9785-1 · DOI
  25. Seo JH, Kim JH, Yang KI, Hong SB. Late use of electronic media and its association with sleep, depression, and suicidality among Korean adolescents. Sleep Med. 2017;29:76-80. doi:10.1016/j.sleep.2016.06.022 · DOI
  26. Augner C, Hacker GW. Associations between problematic mobile phone use and psychological parameters in young adults. Int J Public Health. 2012;57(2):437-441. doi:10.1007/s00038- 011-0234-z · DOI · Paper page
  27. Finkelhor D, Shattuck A, Turner HA, Hamby SL. Trends in children's exposure to violence, 2003 to 2011. JAMA Pediatr. 2014;168(6):540-546. doi: 10.1001/jamapediatrics.2013.5296 · DOI · Paper page
  28. Finkelhor D, Johnson M. Has psychiatric medication reduced crime and delinquency? Trauma Violence Abuse. 2017;18(3):339-347. doi:10.1177/1524838015620817 · DOI
  29. Marcotte DE, Markowitz S. A cure for crime? psycho-pharmaceuticals and crime trends. J Policy Anal Manage. 2010;30(1):29-56. doi:10.1002/ pam.20544 · DOI
  30. Nevin R. Trends in preschool lead exposure, mental retardation, and scholastic achievement: association or causation? Environ Res. 2009;109(3): 301-310. doi:10.1016/j.envres.2008.12.003 · DOI
  31. Nevin R. Understanding international crime trends: the legacy of preschool lead exposure. Environ Res. 2007;104(3):315-336. doi:10.1016/j. envres.2007.02.008 · DOI
  32. Nevin R. How lead exposure relates to temporal changes in IQ, violent crime, and unwed pregnancy. Environ Res. 2000;83(1):1-22. doi:10.1006/enrs.1999.4045 · DOI · Paper page
  33. Carlson LA, Kees NL. Mental health services in public schools: a preliminary study of school counselor perceptions. Prof School Counsel. Published online February 15, 2018. doi:10.1177/ 2156759X12016002S03 · DOI
  34. Stein RE, Horwitz SM, Storfer-Isser A, Heneghan A, Olson L, Hoagwood KE. Do pediatricians think they are responsible for identification and management of child mental health problems? results of the AAP periodic survey. Ambul Pediatr. 2008;8(1):11-17. doi:10.1016/ j.ambp.2007.10.006 · DOI
  35. Girio-Herrera E, Ehrlich CJ, Danzi BA, La Greca AM. Lessons learned about barriers to implementing school-based interventions for adolescents: ideas for enhancing future research and clinical projects. Cognit Behav Pract. 2019;26 (3240):466-477. doi:10.1016/j.cbpra.2018.11.004 · DOI
  36. Aupont O, Doerfler L, Connor DF, Stille C, Tisminetzky M, McLaughlin TJ. A collaborative care model to improve access to pediatric mental health services. Adm Policy Ment Health. 2013;40(4):264- 273. doi:10.1007/s10488-012-0413-0 · DOI
  37. Glied S, Cuellar AE. Trends and issues in child and adolescent mental health. Health Aff (Millwood). 2003;22(5):39-50. doi:10.1377/hlthaff.22.5.39 · DOI
  38. Cama S, Malowney M, Smith AJB, et al. Availability of outpatient mental health care by pediatricians and child psychiatrists in five US cities. Int J Health Serv. 2017;47(4):621-635. doi:10.1177/ 0020731417707492 · DOI · Paper page
  39. Kapphahn C, Morreale M, Rickert VI, Walker L. Financing mental health services for adolescents: a background paper. J Adolesc Health. 2006;39(3): 318-327. doi:10.1016/j.jadohealth.2006.06.002 · DOI
  40. Walter AW, Yuan Y, Cabral HJ. Mental health services utilization and expenditures among children enrolled in employer-sponsored health plans. Pediatrics. 2017;139(suppl 2):S127-S135. doi:10.1542/peds.2016-2786G · DOI
  41. Herman KC, Cho E, Marriott BR, Walker LY. Bridging the gap in psychiatric care for children with a school-based psychiatry program. School Ment Health. 2018;10(2):181-189. doi:10.1007/s12310- 017-9222-7 · DOI
  42. Walter HJ, Kackloudis G, Trudell EK, et al. Enhancing pediatricians' behavioral health competencies through child psychiatry consultation and education. Clin Pediatr (Phila). 2018;57(8):958-969. doi:10.1177/ 0009922817738330 · DOI
  43. Kronström K, Ellilä H, Kuosmanen L, Kaljonen A, Sourander A. Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland. Nord J Psychiatry. 2016;70(6):436-441. doi:10.3109/ 08039488.2016.1149617 · DOI
  44. Larson MJ, Miller K, Fleming KJ, Teich JL. Mental health services for children in large, employer-based health plans, 1999. J Behav Health Serv Res. 2007;34(1):56-72. doi:10.1007/s11414- 006-9028-0 · DOI
  45. Breslau J, Gilman SE, Stein BD, Ruder T, Gmelin T, Miller E. Sex differences in recent first-onset depression in an epidemiological sample of adolescents. Transl Psychiatry. 2017;7(5):e1139. doi:10.1038/tp.2017.105 · DOI

Cited by

Sorted by citations

Authors
Mojtabai, R., & Olfson, M.
Affiliations
  • Johns Hopkins University (US)
  • Columbia University (US)
Corresponding author
Mojtabai, Ramin
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2020-07-01
Volume
77
Issue
7
Pages
703
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2020.0279
PMC
PMC7097842
OpenAlex
W3013874881
Cited by
229
References
13
Citations by year
2026: 28 · 2025: 54 · 2024: 53 · 2023: 30 · 2022: 27 · 2021: 32 · 2020: 5
FWCI
25.69
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
Keywords
adolescent mental health care, mental health service utilization, adolescent depression, internalizing disorders, externalizing disorders, school counseling, psychiatric inpatient care, outpatient psychiatric care, gender differences in treatment, racial and ethnic disparities, insurance status, temporal trends, National Survey on Drug Use and Health, school-based mental health services
MeSH terms
Facilities and Services Utilization, Social Interaction, Adolescent, Ambulatory Care, Mental Disorders, Behavioral Symptoms, Child, Counseling, Cross-Sectional Studies, Depression, Female, Health Surveys, Humans, Male, Mental Health Services, School Health Services, United States, Prevalence, Adolescent Health Services, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review