National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians

Olfson, Mark; Blanco, Carlos; Wang, Shuai; Laje, Gonzalo; Correll, Christoph U.

doi:10.1001/jamapsychiatry.2013.3074

Cited by 387 publications

(291 citation statements)

References 67 publications

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“…[10][11][12][13] Other studies sought to quantify the pediatric mental health care PCPs undertake by analyzing mental health care visits and suggested that PCPs are the providers at more mental health visits than psychiatrists. 14,15 The literature has also explored prescribing patterns of PCPs and psychiatrists, with conflicting results among the studies on which provider type is more likely to prescribe psychotropic medications. 14,16,17 Despite attention to this area of research, no studies have yet used a nationally representative sample to characterize the population of children seen or prescribed medications by PCPs versus other types of mental health providers.…”

Section: What This Study Addsmentioning

confidence: 99%

“…14,15 The literature has also explored prescribing patterns of PCPs and psychiatrists, with conflicting results among the studies on which provider type is more likely to prescribe psychotropic medications. 14,16,17 Despite attention to this area of research, no studies have yet used a nationally representative sample to characterize the population of children seen or prescribed medications by PCPs versus other types of mental health providers. Previous national studies have analyzed pediatric mental health use at the level of visits (and not children), 14 have focused on solely 1 condition, 15 or have used only a subset of children and youth (eg, youth in foster care) in their sample.…”

Section: What This Study Addsmentioning

confidence: 99%

“…14,16,17 Despite attention to this area of research, no studies have yet used a nationally representative sample to characterize the population of children seen or prescribed medications by PCPs versus other types of mental health providers. Previous national studies have analyzed pediatric mental health use at the level of visits (and not children), 14 have focused on solely 1 condition, 15 or have used only a subset of children and youth (eg, youth in foster care) in their sample. 3,18 Knowing nationally which children are treated by PCPs and which children are treated by other providers can help estimate how much PCPs are engaged in mental health care.…”

Section: What This Study Addsmentioning

confidence: 99%

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Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

et al. 2015

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OBJECTIVE: To compare the mental health care US children receive from primary care providers (PCPs) and other mental health care providers.METHODS: Using nationally representative data from the Medical Expenditure Panel Survey (MEPS) from 2008 to 2011, we determined whether children and youth aged 2 to 21 years with outpatient visits for mental health problems in the past year saw PCPs, psychiatrists, and/or psychologists/social workers for these conditions. We compared the proportion of children prescribed psychotropic medications by provider type. Using logistic regression, we examined associations of provider type seen and medication prescribing with race/ethnicity, household income, insurance status, geographical area, and language at home. RESULTS:One-third (34.8%) of children receiving outpatient care for mental health conditions saw PCPs only, 26.2% saw psychiatrists only, and 15.2% saw psychologists/social workers only. Nearly a quarter (23.8%) of children saw multiple providers. A greater proportion of children with attention-deficit/hyperactivity disorder (ADHD) versus children with anxiety/mood disorders saw a PCP only (41.8% vs 17.2%). PCPs prescribed medications to a higher percentage of children than did psychiatrists. Children seeing a PCP for ADHD were more likely to receive stimulants or a-agonists than children with ADHD seeing psychiatrists (73.7% vs 61.4%). We found only limited associations of sociodemographic characteristics with provider type or medication use.

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Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

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Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

et al. 2015

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“…6 The past decade has seen an increase in mental health service use for childhood mental health disorders. 11,12 Mental health treatment expenditures for children 0 to 17 years of age are also on the rise. 13,14 Although there has been an increase in mental health services use among children and adolescents, those in need of mental health services experience gaps in access to care.…”

mentioning

confidence: 99%

Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans

2017

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BACKGROUND AND OBJECTIVES: Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. METHODS: Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007–2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. RESULTS: Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010–2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. CONCLUSIONS: Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans.

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“…36,37 Antipsychotic use, in particular, has shown large increases. 38 Especially notable is their burgeoning off-label use, [39][40][41] including in preschool-aged children.…”

Section: Adverse Effects Of Psychiatric Medicationsmentioning

confidence: 99%

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

Chun¹,

Mace²,

Katz³

2016

Pediatrics

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National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians

Abstract: IMPORTANCE Despite evidence of the increasing use of psychotropic medications, little is known about the broader changes in the delivery of outpatient mental health treatment to children, adolescents, and adults.

Cited by 387 publications

References 67 publications

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions

Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

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