Specialty Mental Health Settings Are Most Common for Treatment of Adolescent Major Depression, Says New Study

By Tom McLaughlin

Treatment for adolescent major depression is most common in specialty mental health settings – and significantly on the rise – followed by educational and general medical settings, according to a new Rutgers University–Camden study.

Lu notes that, each year, around 40 percent of adolescents who received treatment for depression used services in multiple settings.

“These findings may reflect the progress the Affordable Care Act had made in expanding insurance coverage and providing mental health services in the past decade,” says the author, Wenhua Lu, an assistant professor of childhood studies at Rutgers University–Camden. “Continued efforts are needed to improve services for adolescents with major depression, especially in educational and general medical settings.”

Lu examines the national patterns, temporal trends, and factors related to service use across settings in her study, “Treatment for Adolescent Depression: National Patterns, Temporal Trends, and Factors Related to Service Use Across Settings,” published in the Journal of Adolescent Health.

The Rutgers–Camden researcher draws on the National Survey on Drug Use and Health (NSDUH), 2011-2018 for data on adolescents aged 12 to 17 who received treatment for major depression – defined as a cluster of specific symptoms with associated impairments – over a 12-month period. The NSDUH is an annual cross-sectional survey sponsored by the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services.

Adolescents were classified as having experienced a major depressive episode (MDE) over a 12-month period if they were in a depressed mood or lost interest in daily activities for two weeks or longer. Adolescents who experienced an episode were classified as having received treatment if they had seen or spoken to a medical doctor or other professional about their symptoms in the past year.

The Rutgers–Camden researcher also determined that a range of demographic factors, including their age, race, gender, insurance status, family income, and school experiences, significantly influenced adolescents’ service use across settings.

Specialty mental health services were defined as any of six inpatient/residential or outpatient sources: hospital, residential treatment facility, day treatment facility, mental health clinic, private therapist, and in-home therapist. General mental health services consisted of treatment from pediatricians and other family doctors. School-based services included talking to school social workers, psychologists, or counselors.

Each year, around 40 percent of adolescents who received treatment for depression used services in multiple settings, and combined service use in specialty mental health and educational settings was most common. However, Lu notes, adolescents’ multisetting service use did not increase appreciably over time, which may raise some concern about the overall adequacy of partnerships among different service systems in recent years.

She also determined that a range of demographic factors, including their age, race, gender, insurance status, family income, and school experiences, significantly influenced adolescents’ service use across settings.

For instance, Lu found that, for specialty mental health and general medical settings, females were more likely to use services than males, and there were lower odds of Hispanics, blacks, and uninsured adolescents using these services relative to whites and adolescents with insurance coverage.

Moreover, adolescents whose annual family income was $75,000 or above were more likely to use specialty mental health services than those with annual family income of $20,000 or lower. Conversely, adolescents whose family income was less than $20,000 were more likely to use general medical or school-based services than those whose family income was $50,000 and above.

“Strengthened funding and policy support are warranted to expand safety-net mental health services for uninsured, low-income, and racial/ethnic minority adolescents,” writes Lu in the study.

Among her other findings, Lu determined that, although females were more likely to use services in multiple settings, being in the 14-to-17 age range and black decreased this likelihood. Moreover, having MDE-related severe impairment consistently predicts adolescent mental health service use in any setting.

According to the Rutgers–Camden researcher, negative outcomes associated with adolescent major depression include self-injuries, violence, substance abuse, academic failure, and suicide. Furthermore, a recent study shows that, from 2011 to 2016, there was an increase in adolescents who experienced major depression from 8.3 to 13 percent, respectively, but their rates of service use remained below 40 percent.

“It is critical, therefore, to understand patterns of mental health service use among adolescents with depression so that effective interventions can be developed to improve their access to care,” writes Lu.

In collaboration with colleagues from Rutgers University–Camden and East Carolina University, Lu is currently co-editing a special issue on the topic of minority adolescent mental health and health care disparities for the journal Frontiers in Public Health. The special issue is now open for abstract submission.

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