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Cited by 408Mental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional DevelopmentPsychology and Mental Health

Trends in Mental Health Care among Children and Adolescents

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Olfson, Mark, Druss, Benjamin G., Marcus, Steven C.·2015·New England Journal of Medicine
DOI 10.1056/nejmsa1413512
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Abstract

BACKGROUND: Increasing mental health treatment of young people and broadening conceptualizations of psychopathology have triggered concerns about a disproportionate increase in the treatment of youths with low levels of mental health impairment. METHODS: We analyzed the 1996-1998, 2003-2005, and 2010-2012 Medical Expenditure Panel Surveys, which were nationally representative surveys of U.S. households, for trends in outpatient use of mental health services by persons 6 to 17 years of age; 53,622 persons were included in the analysis. Mental health impairment was measured with the use of the Columbia Impairment Scale (range, 0 to 52, with higher scores indicating more severe impairment); we classified youths with scores of 16 or higher as having more severe impairment and those with scores of less than 16 as having less severe impairment. RESULTS: The percentage of youths receiving any outpatient mental health service increased from 9.2% in 1996-1998 to 13.3% in 2010-2012 (odds ratio, 1.52; 95% confidence interval, 1.35 to 1.72). The proportionate increase in the use of mental health services among youths with more severe impairment (from 26.2% to 43.9%) was larger than that among youths with less severe or no impairment (from 6.7% to 9.6%). However, the absolute increase in annual service use was larger among youths with less severe or no impairment (from 2.74 million to 4.19 million) than among those with more severe impairment (from 1.56 million to 2.28 million). Significant overall increases occurred in the use of psychotherapy (from 4.2% to 6.0%) and psychotropic medications (from 5.5% to 8.9%), including stimulants and related medications (from 4.0% to 6.6%), antidepressants (from 1.5% to 2.6%), and antipsychotic drugs (from 0.2% to 1.2%). CONCLUSIONS: Outpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996-1998 and 2010-2012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet fewer than half accessed services in 2010-2012. (Funded by the Agency for Healthcare Research and Quality and the New York State Psychiatric Institute.).

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  • Most adolescents with mental disorders remain untreated or do not receive professional care, especially those with subclinical symptoms.

    “most adolescents with mental disorders remain untreated or do not receive professional care, 3 especially those with subclinical symptoms”

    From Group acceptance and commitment therapy for promoting mental health in schools: a feasibility study. (2025) · cites this paper as [3]

    The service-use table shows that in 2010–2012, 43.5% of adolescents aged 12–17 with more severe impairment and 9.8% with less severe or no impairment used outpatient mental health services. This supports the claim that most did not receive outpatient care, particularly in the less-impaired group. The study measures impairment rather than diagnosed mental disorders or specifically subclinical symptoms, and outpatient service use does not establish whether adolescents received any other professional care. (LLM, conf=0.86)

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  1. [5]5. United States. Fed Regist 1993; 58: 29425.
  2. [21]21. Angold A, Costello EJ, Farmer EMZ, Burns BJ, Erkanli A. Impaired but undiag- nosed. J Am Acad Child Adolesc Psychia- try 1999; 38: 129-37.
  3. [24]24. Smiga SM, Elliott GR. Psychopharma- cology of depression in children and ado- lescents. Pediatr Clin North Am 2011; 58: 155-71.
  4. [33]33. Institute of Medicine. Unequal treat- ment: confronting racial and ethnic dis- parities in health care. Washington, DC: National Academies Press, 2002.

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Authors
Olfson, M., Druss, B. G., & Marcus, S. C.
Affiliations
  • Emory University (US)
  • University of Pennsylvania (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2015-05-21
Volume
372
Issue
21
Pages
2029-2038
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa1413512
OpenAlex
W1559191608
Cited by
408
References
34
Citations by year
2026: 17 · 2025: 32 · 2024: 35 · 2023: 29 · 2022: 32 · 2021: 37 · 2020: 44 · 2019: 63 · 2018: 50 · 2017: 32 · 2016: 30 · 2015: 5 · 2012: 1
FWCI
63.97
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health and Human Services
  • Agency for Healthcare Research and Quality (U19HS021112)
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
outpatient mental health services, children and adolescents, psychotropic drug use, psychotherapy, stimulants, antidepressants, antipsychotic drugs, Medical Expenditure Panel Survey
MeSH terms
Adolescent, Mental Disorders, Child, Child Health Services, Humans, Mental Health Services, Psychotherapy, Psychotropic Drugs, United States, Adolescent Health Services

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