Lee Dennis, Dusetzina Stacie B, Patrick Stephen W, Graves John A, Fry Carrie E
Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles.
Department of Health Policy, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee.
JAMA Health Forum. 2025 Aug 1;6(8):e252647. doi: 10.1001/jamahealthforum.2025.2647.
Recent trends in drug-related overdoses among adolescents have highlighted the need for mental health and substance use disorder (SUD) treatment. However, the extent of these treatment gaps is understudied.
To characterize the factors associated with the diagnosis of and treatment for mental health and SUD for adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used survey-weighted descriptive statistics and χ2 tests to estimate differences in characteristics and treatment receipt and included US adolescents and young adults aged 12 to 20 years who participated in the National Survey on Drug Use and Health in 2021 and 2022. Data were analyzed from February 2024 to February 2025.
Primary outcomes included the prevalence of depression and suicidality-related mental health diagnoses, SUDs, and treatment rates for both conditions. Additional measures included treatment setting, socioeconomic and demographic characteristics, and health insurance-related factors.
From 2021 to 2022, 13% of participants had SUD and 24% had a mental health diagnosis during the previous year (mean [SD] age, 16.0 [2.5] years; 48.4% female individuals; 6.1% Asian, 13.9% Black, 25.7% Hispanic, and 49.9% White individuals). Only 10% of participants with SUD and 51% of adolescents with mental health diagnoses received treatment for their conditions, with higher rates of treatment among adolescents with comorbid SUD and mental health diagnoses. When comparing adolescents (aged 12-17 years) and young adults (aged 18-20 years) with SUD for treatment receipt, reductions were found in any mental health treatment (63% vs 51%; P = .03) and any SUD treatment (11% vs 8%; P = .01). Moreover, these lower rates were also found in more resource-intensive treatment settings, such as inpatient mental health care (14% vs 9%; P = .02) and specialty mental health facilities (47% vs 33%; P = .003). However, adolescents with opioid use disorder were less likely to receive medication treatment (11% vs 28%; P = .02). Treatment differences were associated with socioeconomic and insurance coverage factors. Compared with adolescents, young adults with SUD experienced increased poverty rates (20% vs 26%; P = .02), uninsurance rates (5% vs 10%; P = .05), and private insurance rates (49% vs 56%; P = .02) while receiving decreased Medicaid coverage (47% vs 33%; P < .001) and government assistance (34% vs 25%; P = .001).
The results of this cross-sectional survey study suggest that adolescents and young adults with SUDs rarely received treatment. Adolescents are especially vulnerable to treatment gaps once reaching young adulthood, and medications for opioid use disorder are systematically underused, especially for adolescents.
青少年中与药物相关的过量用药的近期趋势凸显了心理健康和物质使用障碍（SUD）治疗的必要性。然而，这些治疗缺口的程度尚未得到充分研究。
描述与青少年心理健康和SUD诊断及治疗相关的因素。
设计、背景和参与者：这项横断面研究使用调查加权描述性统计和χ²检验来估计特征和治疗接受情况的差异，纳入了2021年和2022年参加全国药物使用和健康调查的12至20岁的美国青少年和青年。数据于2024年2月至2025年2月进行分析。
主要结局包括抑郁和自杀相关心理健康诊断、SUD的患病率以及两种情况的治疗率。其他指标包括治疗环境、社会经济和人口特征以及与健康保险相关的因素。
从2021年到2022年，13%的参与者患有SUD，24%的参与者在上一年有心理健康诊断（平均[标准差]年龄，16.0[2.5]岁；48.4%为女性；6.1%为亚洲人，13.9%为黑人，25.7%为西班牙裔，49.9%为白人）。只有10%的SUD参与者和51%的有心理健康诊断的青少年接受了相应疾病的治疗，患有合并SUD和心理健康诊断的青少年的治疗率更高。在比较患有SUD的青少年（12至17岁）和青年（18至20岁）的治疗接受情况时，发现接受任何心理健康治疗的比例有所下降（63%对51%；P = 0.03），接受任何SUD治疗的比例也有所下降（11%对8%；P = 0.01）。此外，在更资源密集型的治疗环境中，如住院心理健康护理（14%对9%；P = 0.02）和专科心理健康设施（47%对33%；P = 0.003）中，这些比例也较低。然而，患有阿片类物质使用障碍的青少年接受药物治疗的可能性较小（11%对28%；P = 0.02）。治疗差异与社会经济和保险覆盖因素有关。与青少年相比，患有SUD的青年贫困率上升（20%对26%；P = 0.02），未参保率上升（5%对10%；P = 0.05），私人保险率上升（49%对56%；P = 0.02），而医疗补助覆盖范围下降（47%对33%；P < 0.001），政府援助下降（34%对25%；P = 0.001）。
这项横断面调查研究的结果表明，患有SUD的青少年和青年很少接受治疗。青少年一旦进入青年期，特别容易出现治疗缺口，阿片类物质使用障碍的药物系统性使用不足，尤其是对青少年而言。
