Black Sarah R, Fristad Mary A, Arnold L Eugene, Birmaher Boris, Findling Robert L, Youngstrom Eric A, Horwitz Sarah M
Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Departments of Psychology and Nutrition, The Ohio State University, Columbus, OH, USA.
Evid Based Pract Child Adolesc Ment Health. 2019;4(2):113-121. doi: 10.1080/23794925.2018.1501328. Epub 2018 Aug 24.
Rates of treatment utilization decline as adolescents make the transition to adulthood even though young adults are particularly vulnerable to the negative outcomes of untreated mental illness. Although a variety of factors have been explored to explain decreased treatment utilization in this age group, previous research has almost exclusively employed cross-sectional methods rather than following a group of youth as they enter adulthood. The current study aims to address this methodological limitation by assessing treatment utilization in emerging adults who began participating in a longitudinal study during childhood. One hundred and thirty seven youth who turned 18 during the 96-month follow-up period were included in the current analyses. Demographic and socioeconomic variables such as sex, race, and insurance status and clinical variables such as psychiatric diagnoses and perceptions of treatment effectiveness were investigated as factors potentially associated with outpatient treatment use before and after age 18. Prior to age 18, youth reported using outpatient services at 75% of their visits, but after age 18, outpatient treatment utilization dropped to around 50%. White race, increased parental stress, and increased parental perception of treatment usefulness were associated with greater treatment use prior to age 18, whereas only increased youth perception of symptom-related dysfunction were associated with increased treatment use after age 18. Findings point to the importance of including youth preferences and perceptions of dysfunction in treatment decisions across adolescence in order to optimize treatment use following the transition to adulthood.
尽管青年特别容易受到未治疗精神疾病负面后果的影响，但随着青少年向成年过渡，治疗利用率会下降。虽然已经探讨了多种因素来解释这一年龄组治疗利用率下降的原因，但以往的研究几乎完全采用横断面方法，而不是跟踪一组青少年进入成年期的情况。本研究旨在通过评估在儿童期开始参与纵向研究的新兴成年人的治疗利用率来解决这一方法学上的局限性。本分析纳入了在96个月随访期内年满18岁的137名青少年。研究了人口统计学和社会经济变量，如性别、种族和保险状况，以及临床变量，如精神疾病诊断和对治疗效果的看法，作为18岁前后与门诊治疗使用可能相关的因素。18岁之前，青少年报告在75%的就诊中使用门诊服务，但18岁之后，门诊治疗利用率降至约50%。白人种族、父母压力增加以及父母对治疗有用性的认知增加与18岁之前更多地使用治疗相关，而只有青少年对症状相关功能障碍的认知增加与18岁之后治疗使用增加相关。研究结果表明，在整个青春期的治疗决策中纳入青少年的偏好和对功能障碍的认知非常重要，以便在向成年过渡后优化治疗使用。
