Adolescent use of care for behavioural and emotional problems: types, determinants and trends

Abstract

SA Reijneveld, PA Wiegersma, DEMC Jansen Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Contact: s.a.reijneveld@umcg.nl Background Adolescents frequently have behavioural and emotional problems, that limit their daily functioning. A minority of them receives care. Evidence on determinants and types of care used, including the role of specialized vs. general care is lacking. Objective: To assess the use of various types of care by adolescents because of behavioural and emotional problems, the determinants of this use, and to what extent these determinants explain trends in use by age, for ages 10-19 years. Design/Methods We obtained longitudinal data on 2,230 adolescents during ages 10-19 years in four measurement waves. Data concerned use of various types of care (general including paediatric care, and specialized car i.e. youth social care, and youth mental healthcare) in the preceding 6 months, behavioural and emotional problems (CBCL), and child and family characteristics. We used multilevel logistic regression to analyse the effects of determinants on use per type of care. Results At all ages, use of general care was higher than of specialized care. Overall rates of use increased from 20.1% at age 10/11 to 32.2%. at 19. At age 10/11 use was higher among boys than among girls, but towards age 19, it more than doubled among girls while being rather stable among boys. Use of general care increased among both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change could partially be accounted for by a few factors, being CBCL externalizing and internalizing problems, school problems, family socioeconomic status (SES) and parental divorce. Moreover, use of general care was more likely among low and medium SES families (odds ratios, OR: 1.52 (1.23; 1.88) and 1.40 (1.17;1.67). Use of social care was more likely in case of parental divorce (OR 2.07 (1.36; 3.17) and special education, OR 2.66 (1.78; 3.95), and use of mental healthcare in special education, OR 2.66 (1.60; 4.51). Conclusions Adolescents with behavioural and emotional problems most frequently use general care provided by e.g. general practitioners and child health physicians. Overall use increases with age in girls. Social care or mental health care is used relatively more frequently if adolescents have more behavioral and emotional problems, and receive special education. Key messages Adolescents with behavioural and emotional problems most frequently use general care provided by e.g. general practitioners and child health physicians. Overall use increases in particular in girls from age 11 to age 19, and increases in behavioral and emotional problems explain this partially.