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Articles   |    
Use of Outpatient Mental Health Services Among Children of Different Ages: Are Younger Children More Seriously Ill?
Sarah M. Horwitz, Ph.D.; Amy Storfer-Isser, Ph.D.; Christine Demeter, M.A.; Eric A. Youngstrom, Ph.D.; Thomas W. Frazier, Ph.D.; Mary A. Fristad, Ph.D., A.B.P.P.; L. Eugene Arnold, M.D.; David Axelson, M.D.; Boris Birmaher, M.D.; Robert A. Kowatch, M.D., Ph.D.; Robert L. Findling, M.D., M.B.A.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300209
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Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: sarah.horwitz@nyumc.org). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The study compared use of specialty outpatient mental services among children ages six and seven and children ages eight through 12 and investigated predictors of differences in the patterns of service use by age.

Methods  Eligible children were first-time patients of clinics participating in the Longitudinal Assessment of Manic Symptoms who were between ages six and 12 and who were English speaking. Children who screened positive for symptoms of mania (N=1,124) were invited to participate, and families of 621 (55%) children consented. A matched sample of 86 children without a positive screen for mania also participated. Baseline interviews assessed sociodemographic characteristics of the child and family and the child’s functioning, diagnoses, and use of services.

Results  Of the 707 children, 30% were younger, and 50% used multiple types of specialty outpatient services. Younger children were more likely to be male, have Medicaid insurance, and have two parents with mental health problems. Use of multiple types of services was related to study site, high depression scores, fewer minor health issues, and fewer stressful life events among younger children and with parental stress, primary diagnosis, poor functioning, and not living with both parents among older children. Younger children were much more likely than older children to have used services before age six.

Conclusions  Younger children showed very early use of multiple types of services for mental health problems and a pattern of persistent impairment despite long-standing use of services. These data argue strongly for focusing on emotional and behavioral issues among young children.

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Table 1Characteristics of 707 children in the Longitudinal Assessment of Manic Symptoms, by age and number of types of services used
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a Younger children were ages 6 or 7; older children were ages 8–12.

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b Measured by the Parent Stress Survey. Possible scores range from 0 to 25, with higher scores indicating a greater number of stressful parenting events.

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c CWRU, Case Western Reserve University; OSU, Ohio State University

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Table 2Diagnoses and level of functioning of 707 children in the Longitudinal Assessment of Manic Symptoms, by age and number of types of services used
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a Younger children were ages 6 or 7; older children were ages 8–12.

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b Children’s Depression Rating Scale–Revised. Possible scores range from 17 to 113, with higher scores indicating greater depressive symptomatology.

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c Children’s Global Assessment Scale. Possible scores range from 1 to 100, with higher scores indicating less impairment.

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d Stressful Life Events Schedule. Possible scores range from 0 to 80, with higher scores indicating a greater number of stressful life events.

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e Adolescent version of the Longitudinal Interval Follow-up Evaluation. Possible scores range from 4 to 20, with higher scores indicating lower functioning.

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f The KINDL-R is a parent-report measure of children’s quality of life that has been translated into many languages, including English, from the original German. Possible scores range from 0 to 100, with higher scores indicating better functioning.

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Table 3Association of sociodemographic and clinical characteristics and use of multiple types of outpatient mental health services among younger and older childrena
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a Younger children were ages 6 or 7; older children were ages 8–12.

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b CWRU, Case Western Reserve University; OSU, Ohio State University

Table Footer Note

c Measured by the Parent Stress Survey. Possible scores range from 0 to 25, with higher scores indicating a greater number of stressful parenting events.

Table Footer Note

d Adolescent version of the Longitudinal Interval Follow-up Evaluation. Possible overall scores for the previous functioning subscale range from 4 to 20, with higher scores indicating lower functioning.

Table Footer Note

e Stressful Life Events Schedule. Possible scores range from 0 to 80, with higher scores indicating a greater number of stressful life events.

Table Footer Note

f The KINDL-R is a parent-report measure of children’s quality of life that has been translated into many languages, including English, from the original German. Possible scores on the physical subscale range from 0 to 100, with higher scores indicating better functioning.

Table Footer Note

g Children’s Depression Rating Scale–Revised. Possible scores range from 17 to 113, with higher scores indicating greater depressive symptomatology.

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Table 4Lifetime use of mental health services among children receiving specialty outpatient mental health services, by agea
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a Younger children were ages 6 or 7; older children were ages 8–12.

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