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Treatment of mental illness in American adolescents varies widely within and across areas

Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes.

Emily Cuddy and Janet Currie

PNAS September 29, 2020 117 (39): 24039-24046.

ECONOMICS

Significance

This study uses a large national database of insured adolescent children who have an initial insurance claim for a mental illness. Many of these children either fail to receive follow-up care within 3 mo, or receive care that appears to fall short of standard guidelines for the initial treatment of mental illness in children. The majority do not receive therapy, and many children receive drugs that raise a red flag, such as benzodiazepines, tricyclic antidepressants, and drugs that are not Food and Drug Administration-approved for use in children. Very little of the variation in these outcomes can be explained by shortages of mental health professionals.

Abstract

Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes. We also found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: Overall, in the first 3 mo after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age. On average, these children are 12 y old. While the supply of mental health professionals impacts treatment choices, little of the overall variation is explained by supply-side variables, and at least half of the variation in treatment outcomes occurs within zip codes. These results suggest that other factors, such as physician practice style, may play an important role in the types of treatment that children receive.

 

See: https://www.pnas.org/content/117/39/24039

Figure 1:

Breakdowns of the type of treatment received in the first 3 mo after an initial mental illness claim (A) and the type of drug received, if any drug treatment was received (B). The numbers of observations for A and B are 202,066 and 57,717, respectively. Red-flag prescribing includes benzodiazepines, TCA, and drugs that are not FDA-approved given the child’s age.

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