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Service utilization for lifetime mental disorders in U.S. Adolescents: Results of the national comorbidity survey-adolescent supplement (NCS-A)
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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, 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]
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“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]
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“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
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“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
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“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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Mennies, R. J., Birk, S. L., Norris, L. A., & Olino, T. M. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-020-00687-8 · Cited by 38
Niermann, H. C. M., Voss, C., Pieper, L., Venz, J., Ollmann, T. M., & Beesdo-Baum, K. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102453 · Cited by 39
Hearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.09.052 · Cited by 38
Social phobia and educational and interpersonal impairments in adolescence: a prospective study
Ranta, K., La Greca, A. M., Kaltiala-Heino, R., & Marttunen, M. (2016) · Child Psychiatry & Human Development · doi:10.1007/s10578-015-0600-9 · Cited by 36
Time-to-treatment of mental disorders in a community sample of Dutch adolescents. A TRAILS study
Raven, D., Jörg, F., Visser, E., Oldehinkel, A. J., & Schoevers, R. A. (2017) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796016000226 · Cited by 36
Dietvorst, E., Aukes, M. A., Legerstee, J. S., Vreeker, A., Hrehovcsik, M. M., Keijsers, L., & Hillegers, M. H. J. (2022) · JMIR Formative Research · doi:10.2196/29832 · Cited by 35
Sterling, S., Parthasarathy, S., Jones, A., Weisner, C., Metz, V., Hartman, L., Saba, K., & Kline-Simon, A. H. (2022) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.11.033 · Cited by 33
“Equally concerning is that fewer than half of adolescents needing treatment for substance use or mental health problems receive it [11].”
BackgroundLyon, A. R., Corbin, C. M., Brown, E. C., Ehrhart, M. G., Locke, J., Davis, C., Picozzi, E., Aarons, G. A., & Cook, C. R. (2022) · Implementation Science · doi:10.1186/s13012-022-01222-7 · Cited by 41
Cervin, M., & Lundgren, T. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13485 · Cited by 34
Vance, A., Ferrin, M., Winther, J., & Gomez, R. (2013) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-013-9721-4 · Cited by 33
Implicit bias of encoded variables: frameworks for addressing structured bias in EHR–GWAS data
Dueñas, H. R., Seah, C., Johnson, J. S., & Huckins, L. M. (2020) · Human Molecular Genetics · doi:10.1093/hmg/ddaa192 · Cited by 31
Computer-based Treatment Programs for Youth Anxiety: A Systematic Review
Donovan, C. L., & March, S. (2014) · Psychopathology Review · doi:10.5127/pr.033613 · Cited by 25
Wiljer, D., Abi-Jaoude, A., Johnson, A., Ferguson, G., Sanches, M., Levinson, A., Robb, J., Heffernan, O., Herzog, T., Chaim, G., et al. (2016) · JMIR Research Protocols · doi:10.2196/resprot.6446 · Cited by 26
Khazanov, G. K., Cui, L., Merikangas, K. R., & Angst, J. (2015) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-014-9885-6 · Cited by 24
Self-citationAnestis, J. C., Charles, N. E., Lee-Rowland, L. M., Barry, C. T., & Gratz, K. L. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2019.07.001 · Cited by 17
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Economic evaluation of an online single-session intervention for depression in Kenyan adolescents.
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“While there have been recent increases in diagnoses of internalizing disorders in youth,(10) estimates indicate that only a small portion of symptomatic children and adolescents receive any treatment.(11,12) Indeed, those with a severe presentation are most likely to receive services,(2) and while school services may…”
BackgroundPathways to Sustainability: 8-Year Follow-Up From the PROSPER Project
Welsh, J. A., Chilenski, S. M., Johnson, L., Greenberg, M. T., & Spoth, R. L. (2016) · The Journal of Primary Prevention · doi:10.1007/s10935-016-0421-z · Cited by 17
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Droege, J. R. (2017) · SOJ Nursing & Health Care · doi:10.15226/2471-6529/3/2/00130 · Cited by 18
Youth mental health service preferences and utilization patterns among Latinx caregivers
Vázquez, A. L., Alvarez, M. D. L. C., Navarro Flores, C. M., González Vera, J. M., Barrett, T. S., & Domenech Rodríguez, M. M. (2021) · Children and Youth Services Review · doi:10.1016/j.childyouth.2021.106258 · Cited by 14
Vázquez, A. L., Culianos, D., Flores, C. M. N., Alvarez, M. D. L. C., Barrett, T. S., & Domenech Rodríguez, M. M. (2022) · Child & Youth Care Forum · doi:10.1007/s10566-021-09656-8 · Cited by 15
Metadata
- 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)
- 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
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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