Dir Allyson L, Pederson Casey A, Ouyang Fangqian, Monahan Patrick O, Schwartz Katherine, Wiehe Sarah E, Aalsma Matthew C
Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis.
Psychiatr Serv. 2023 Apr 1;74(4):374-380. doi: 10.1176/appi.ps.202100513. Epub 2023 Jan 4.
Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents.
Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit.
A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001).
These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.
患有行为健康障碍（即精神健康障碍和物质使用障碍）的青少年经常出现症状频繁复发的情况，这表明需要持续的行为健康干预，而不是单一疗程的治疗。然而，对于青少年在更长时期内的精神卫生保健服务使用情况知之甚少。作者研究了一大群青少年门诊行为健康服务利用的纵向模式。
研究了2006年至2017年间印第安纳州一个县的8197名青少年（年龄10.0 - 13.9岁，平均±标准差 = 11.5±1.2；61%为男性）的医疗补助申请，重点是门诊心理治疗就诊情况。潜在类别分析（LCA）用于检测从青少年首次行为健康就诊开始的5年期间门诊心理治疗就诊的纵向模式集群。
出现了一个五类LCA模型，基于每月门诊心理治疗就诊的持续时间和参与程度（频率）划分出独特的服务使用类别。大多数青少年属于未使用类别（占样本的38.7%）。其他类别被定义为晚发性低参与度（17.1%）、早发性高参与度（15.5%）、早发性中等参与度（16.7%）和持续高参与度（11.9%）。各类别在平均持续时间和参与频率（p<0.001）以及人口统计学特征（种族、年龄、性别和族裔）和行为健康诊断方面（p<0.001）存在统计学显著差异。
这些发现证实，患有行为健康诊断的青少年在心理治疗利用方面没有统一模式。不同的服务使用模式表明需要为青少年确定适当的长期服务建议。
