Edwards Jordan, Wang Li, Fuller Anne E, Anderson Kelly K, de Oliveira Claire, Georgiades Katholiki
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.
Can J Psychiatry. 2025 Feb;70(2):127-135. doi: 10.1177/07067437241300961. Epub 2025 Jan 6.
To examine factors associated with high intensity physician-based mental health care services in a population-based sample of children and youth in Ontario, Canada.
Data from the 2014 Ontario Child Health Study (OCHS) were linked at the person-level to longitudinal health administrative databases containing physician contacts in outpatient settings, emergency departments and hospitals. Our analytical sample (15.8% of 9,301, = 1,423) included children and youth with at least one physician-based contact for a mental health concern in the 24-month period post-OCHS. Over the same follow-up period, we classified high intensity service use as those in the top 10th and fifth percentiles of physician-based mental health service cost contributors. Costs were assessed using physician billing data, as well as estimated emergency department visit and hospitalization costs.
Among those with at least one contact, being older (PR: 1.15, 95% CI: 1.04, 1.25), having more severe symptoms of mental ill-health (PR: 1.04, 95% CI: 1.01, 1.06) and having a history of mental health service use (PR: 3.99, 95% CI: 1.37, 11.61), were positively associated with high-intensity service use, while living in a rural setting (PR: 0.35, 95% CI: 0.15, 0.30) was negatively associated. Findings were largely consistent between the top 10th and fifth percentiles. Notably, among youth ages 14-17 years, self-reported prior suicide attempt was positively associated with high-intensity (top fifth percentile) service use (PR: 6.09, 95% CI: 1.41, 26.26).
Our findings suggest older age, non-rural residency, mental health symptom severity and suicidal behaviour are important factors associated with high-intensity physician-based mental health service use. Our findings will inform efforts to better identify children and youth who may benefit from early and personalized interventions.
Understanding Children and Youth with the Greatest Mental Health Related Service Needs.
在加拿大安大略省以人群为基础的儿童和青少年样本中，研究与高强度基于医生的心理健康护理服务相关的因素。
2014年安大略儿童健康研究（OCHS）的数据在个人层面与纵向健康管理数据库相链接，该数据库包含门诊、急诊科和医院的医生接触信息。我们的分析样本（9301人的15.8%，即1423人）包括在OCHS后24个月内至少有一次因心理健康问题与医生接触的儿童和青少年。在同一随访期内，我们将高强度服务使用定义为基于医生的心理健康服务成本贡献处于前10%和前5%的人群。使用医生计费数据以及估计的急诊科就诊和住院成本来评估成本。
在至少有一次接触的人群中，年龄较大（风险比：1.15，95%置信区间：1.04，1.25）、心理健康问题症状更严重（风险比：1.04，95%置信区间：1.01，1.06）以及有心理健康服务使用史（风险比：3.99，95%置信区间：1.37，11.61）与高强度服务使用呈正相关，而居住在农村地区（风险比：0.35，95%置信区间：0.15，0.30）与高强度服务使用呈负相关。在前10%和前5%人群中的研究结果基本一致。值得注意的是，在14 - 17岁的青少年中，自我报告的既往自杀未遂与高强度（前5%）服务使用呈正相关（风险比：6.09，95%置信区间：1.41，26.26）。
我们的研究结果表明，年龄较大、非农村居住、心理健康症状严重程度和自杀行为是与高强度基于医生的心理健康服务使用相关的重要因素。我们的研究结果将为更好地识别可能从早期和个性化干预中受益的儿童和青少年的努力提供信息。
了解心理健康相关服务需求最大的儿童和青少年
