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Cited by 1,579Mental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional DevelopmentPsychology and Mental Health

Service utilization for lifetime mental disorders in U.S. Adolescents: Results of the national comorbidity survey-adolescent supplement (NCS-A)

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Merikangas, Kathleen Ries, He, Jian-ping, Burstein, Marcy, Swendsen, Joel, Avenevoli, Shelli, Case, Brady, Georgiades, Katholiki, Heaton, Leanne +2 more·2011·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2010.10.006PMC PMC4408275
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Abstract

Objective Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation are to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement (NCS-A). Method Face-to-face survey of mental disorders from 2002-2004 using a modified version of the fully-structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents aged 13-18 years for whom information on service use was available from both an adolescent and a parent report. Both total and sector-specific mental health service use was also assessed. Results Approximately one-third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest among those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but less than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly among youth with behavior disorders. Hispanic and non-Hispanic black adolescents were less likely than their white counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. Conclusions Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.

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  • In the USA, the education sector is responsible for 50-80% of all mental healthcare.

    “In the USA, studies consistently indicate that the education sector is the most heavily accessed youth mental health service setting, responsible for 50–80% of all mental healthcare [4, 41–45].”

    From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [45]

    The Results (Service Utilization by Service Sector and Number of Visits) report that 35.4% of adolescents with a disorder were seen in a school setting, compared with 46.5% in specialty mental health services. The Discussion calls specialty mental health the dominant locus of care. This paper therefore does not support the claim that education was the most-accessed setting or responsible for 50–80% of care. (LLM, conf=0.90)

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  • In the USA, the education sector is the most heavily accessed youth mental health service setting.

    “In the USA, studies consistently indicate that the education sector is the most heavily accessed youth mental health service setting, responsible for 50–80% of all mental healthcare [4, 41–45].”

    From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [45]

    The Results (Service Utilization by Service Sector and Number of Visits) report that 46.5% of adolescents with a disorder used specialty mental health services, versus 35.4% who used school services. The Discussion explicitly calls specialty mental health the dominant setting; it describes schools as the primary setting only in an earlier rural study, not in this national study. (LLM, conf=0.94)

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  • Young people struggling with internalising symptoms such as anxiety and depression are much less noticeable and less likely to seek therapeutic intervention than those with externalising symptoms.

    “Young people struggling particularly with internalising symptoms such as anxiety and depression are much less noticeable and less likely to seek therapeutic intervention than those with externalising symptoms.”

    From Maladaptive Perfectionism, Disguised Distress, and Help Seeking in the Culture of 'Saving Face': Links to Anxiety and Depressive Symptoms among Asian Youth (2019) · cites this paper as Merikangas et al., 2011

    The Discussion (page unavailable) says externalizing conditions are often recognized through observable behavior, whereas mood and anxiety disorders may require self-recognition or close family observation. The Results (page unavailable) report lower treatment rates for anxiety (17.8%) and mood disorders (37.7%) than for ADHD (59.8%) and other behavior disorders (45.4%). The claim overstates the size of the difference for depression: the reported mood-disorder rate is only modestly below the behavior-disorder rate. (LLM, conf=0.85)

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  • In a clinical assessment of 6,000 US adolescents aged 13-18, only about 36.2% of adolescents with an identifiable mental health disorder received treatment.

    “In a widespread clinical assessment of 6,000 adolescents aged 1318 years old in the US, researchers found that only about a third (36.2%) of adolescents with an identifiable mental health disorder received treatment.”

    From Maladaptive Perfectionism, Disguised Distress, and Help Seeking in the Culture of 'Saving Face': Links to Anxiety and Depressive Symptoms among Asian Youth (2019) · cites this paper as Merikangas et al., 2011

  • Two-thirds of diagnosed youth do not receive the help they need.

    “While clinician-led cognitive behavior therapy effectively improves IU, several barriers including stigma, time, and financial costs prevent access to, and engagement with, evidence-based care (Brown, Rice, Rickwood, & Parker, 2016; van den Heuvel, Barozzino, Milligan, Ford-Jones, & Freeman, 2016), with two-thirds of diagnosed youth not receiving the help they need (Merikangas et al., 2011).”

    From A single session online training reduces intolerance of uncertainty and improves mental health in emerging adults. (2025) · cites this paper as Merikangas et al., 2011

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Authors
Merikangas, K. R., He, J.-P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., Georgiades, K., Heaton, L., Swanson, S., & Olfson, M.
Affiliations
  • National Institute of Mental Health (US)
  • Centre National de la Recherche Scientifique (FR)
  • Nathan Kline Institute for Psychiatric Research (US)
  • McMaster University (CA)
  • Columbia University Irving Medical Center (US)
Corresponding author
Merikangas, Kathleen Ries
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2011-01
Volume
50
Issue
1
Pages
32-45
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2010.10.006
PMC
PMC4408275
OpenAlex
W1994618257
Semantic Scholar
cb8ef1c0fa7b5563715b8552fe94b21ab16ab756
Cited by
1,579
References
58
Citations by year
2026: 47 · 2025: 63 · 2024: 104 · 2023: 99 · 2022: 122 · 2021: 167 · 2020: 143 · 2019: 155 · 2018: 119 · 2017: 122 · 2016: 107 · 2015: 98 · 2014: 100 · 2013: 71 · 2012: 45
FWCI
57.72
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • John W. Alden Trust
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • World Health Organization
  • McMaster University
  • York University
  • Centre National de la Recherche Scientifique
  • National Institutes of Health
  • School of Medicine, New York University
  • National Institute of Mental Health (U01-MH-60220, MH60220, ZIAMH002808, U01MH060220)
  • National Institute on Drug Abuse (R01DA016558)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
Keywords
mental health service utilization, adolescents, treatment gap, comorbidities, disorder severity, racial disparities, Latino youth, non-Hispanic Black adolescents, attention deficit hyperactivity disorder, behavior disorders, mood disorders, anxiety disorders, eating disorders, substance use disorders, mental health policy
MeSH terms
Adolescent, Mental Disorders, Health Services Needs and Demand, Health Surveys, Humans, Interview, Psychological, Long-Term Care, Mental Health Services, Psychiatric Status Rating Scales, Severity of Illness Index, Socioeconomic Factors, United States, Comorbidity, Mental Competency, Diagnostic and Statistical Manual of Mental Disorders, Healthcare Disparities

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