Adolescents' use of care for behavioral and emotional problems: types, trends, and determinants.

Sijmen A Reijneveld,Frank C Verhulst,Danielle E M C Jansen,P Auke Wiegersma,Wilma A M Vollebergh,Johan Ormel,Evelyn Kroesbergen

doi:10.1371/journal.pone.0093526

Sijmen A Reijneveld, Frank C Verhulst + Show 5 more

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https://doi.org/10.1371/journal.pone.0093526

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Abstract

ObjectiveWhile adolescents use various types of care for behavioral and emotional problems, evidence on age trends and determinants per type is scarce. We aimed to assess use of care by adolescents because of behavioral and emotional problems, overall and by type, and its determinants, for ages 10–19 years.MethodsWe obtained longitudinal data on 2,230 adolescents during ages 10–19 from four measurements regarding use of general care and specialized care (youth social care and mental healthcare) in the preceding 6 months, the Child Behavior Checklist (CBCL) and Youth Self-Report, and child and family characteristics. We analyzed data by multilevel logistic regression.ResultsOverall rates of use increased from 20.1% at age 10/11 to 32.2% at age 19: general care was used most. At age 10/11 use was higher among boys, at age 19 among girls. Use of general care increased for both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change was associated with CBCL externalizing and internalizing problems, school problems, family socioeconomic status, and parental divorce. Preceding CBCL problems predicted more use: most for mental health care and least for general care. Moreover, general care was used more frequently by low and medium socioeconomic status families, with odds ratios (95%-confidence intervals): 1.52 (1.23;1.88) and 1.40 (1.17;1.67); youth social care in case of parental divorce, 2.07 (1.36;3.17); and of special education, 2.66 (1.78;3.95); and mental healthcare in case of special education, 2.66 (1.60;4.51).DiscussionAdolescents with behavioral and emotional problems use general care most frequently. Overall use increases with age. Determinants of use vary per type.

Highlights

Estimates of rates of behavioral and emotional problems among adolescents vary from 10 to 25%
We examined the associations with current needs, that is, current Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) scores, and with previous needs, that is, CBCL and YSR scores during the preceding assessment
Looking at types of care, the increases for girls occurred in both general care and specialized care, whereas for boys an increase only occurred for use of general care

Summary

Introduction

Estimates of rates of behavioral and emotional problems among adolescents vary from 10 to 25%. These problems may lead to restrictions in their daily functioning and to severe long-term effects. [9] evidence concerning the influence of these determinants is inconclusive This may be due to differences in the types of care that were studied, in the factors that were assessed, and in the ages of the adolescents involved. [6] Use of any care for behavioral and emotional problems has been shown to vary by age. A study of Ford and co-authors shows that determinants of use of primary care varies by age, with only child behavioral problems playing a role at ages 5–10, whereas more factors contributed at ages 11–15. ‘‘ 2 (13.6 years) ‘‘ 3 (16.2 years) ‘‘ 4 (19.1 years) Female * wave 1 ‘‘ * wave 2 ‘‘ * wave 3 ‘‘ * wave 4 Predisposing factors SES of family (T1) (reference is high) low Medium One-parent family (T1) yes (vs. no) Rec. par. divorce (T2) yes (vs. no) Non-Dutch ethnicity (T1) yes (vs. no) Rural (T1) (vs. urban, .1000) Progress at school (T1) (reference is regular) special education repeated 1 or 2 skipped class Child school level (T2) (ref. is higher secondary) primary/special lower/vocational secondary Enabling factors Social support father (T1) Social support mother (T1) Social support friends (T1) Self-competence learning (T1) Self-competence friends (T1) Self-competence sport (T1) Self-competence appearance (T1) Self-competence behavior (T1) Self-competence general (T1) Need factors CBCL Externalizing, current (T1–T3) CBCL Internalizing, current (T1–T3) YSR Externalizing, current (T1–T3) YSR Internalizing, current (T1–T3) CBCL Externalizing, preceding (T2–T4)# CBCL Internalizing, preceding (T2–T4)# YSR Externalizing, preceding (T2–T4)# YSR Internalizing, preceding (T2–T4)#

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