Okado Yuko, Ewing Emily, Rowley Christina, Jones Damon E
Department of Psychology, California State University, Fullerton, Fullerton, California.
Department of Psychology, California State University, Fullerton, Fullerton, California.
J Adolesc Health. 2017 Aug;61(2):198-204. doi: 10.1016/j.jadohealth.2017.02.012. Epub 2017 Apr 21.
To inform efforts to reduce costly service utilization, the present study examined longitudinal trajectories of mental health-related outpatient and residential service use among at-risk youth with a history of early externalizing problems.
A cohort of 809 children in the Fast Track Project, a multisite longitudinal study of children at risk for conduct disorder, were followed prospectively from kindergarten through 12th grade. They resided in high-risk areas with high rates of poverty, crime, and violence. Their outpatient and residential service use was assessed annually between sixth and 12th grades through parent report. Growth mixture modeling was applied to model individual differences in trajectories of service use during this period. Teacher, parent, and observer-reported childhood predictors of those trajectories were also examined.
Most youths had minimal service use during preadolescence into adolescence. However, approximately 31% had moderate probability of using outpatient counseling services, and approximately 8% had elevated probability of seeing a family doctor for mental health needs. For residential services, approximately 6% had moderate to high probability of service use that peaked during transition to high school, whereas close to 5% had service use that dramatically increased during high school. Childhood predictors of these trajectories included earlier externalizing, internalizing, and emotion regulation problems.
This study is the first to use person-centered analytic methods to examine longitudinal trajectories in mental health-related service use among at-risk adolescents. Timely treatment for severe externalizing problems, comorbid internalizing problems, and emotion dysregulation during childhood may be crucial for preventing chronic service use.
为了指导降低高成本服务利用的工作，本研究考察了有早期外化问题史的高危青少年心理健康相关门诊和住院服务使用的纵向轨迹。
快速通道项目中有809名儿童的队列，这是一项对有品行障碍风险儿童的多地点纵向研究，从幼儿园到12年级进行前瞻性跟踪。他们居住在贫困、犯罪和暴力发生率高的高危地区。通过家长报告，在六年级到十二年级期间每年评估他们的门诊和住院服务使用情况。应用生长混合模型来模拟这一时期服务使用轨迹的个体差异。还考察了教师、家长和观察者报告的这些轨迹的童年预测因素。
大多数青少年在青春期前到青春期期间服务使用极少。然而，约31%的青少年有中度使用门诊咨询服务的可能性，约8%的青少年因心理健康需求看家庭医生的可能性较高。对于住院服务，约6%的青少年有中度到高度的服务使用可能性，在升入高中时达到峰值；而近5%的青少年在高中期间服务使用急剧增加。这些轨迹的童年预测因素包括早期外化、内化和情绪调节问题。
本研究首次使用以个体为中心的分析方法来考察高危青少年心理健康相关服务使用的纵向轨迹。儿童期严重外化问题、共病内化问题和情绪失调的及时治疗对于预防长期服务使用可能至关重要。
