Abstract
SummaryBackgroundEvidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services.MethodsAs part of a longitudinal cohort study, between April 28, 2005, and March 17, 2010, we recruited 1238 14-year-old adolescents and their primary caregivers from 18 secondary schools in Cambridgeshire, UK. Participants underwent follow-up assessment at months 18 and 36. Trained researchers assessed the adolescents for current mental disorder using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Caregivers and adolescents reported contact with mental health services in the year before baseline. Adolescents self-reported depressive symptoms (Mood and Feelings Questionnaire [MFQ]) at each timepoint. We assessed change in MFQ sum scores from baseline contact with mental health services using multilevel mixed-effects regression adjusted for sociodemographic, environmental, individual, and mental health confounders, with multiple imputation of missing data. We used propensity score weighting to balance confounders between treatment (users of mental health services) and control (non-users of mental health services) groups. We implemented an MFQ clinical cutoff following the results of receiver operating characteristic analysis.Findings14-year-old adolescents who had contact with mental health services in the past year had a greater decrease in depressive symptoms than those without contact (adjusted coefficient −1·68, 95% CI −3·22 to −0·14; p=0·033). By age 17 years, the odds of reporting clinical depression were more than seven times higher in individuals without contact than in service users who had been similarly depressed at baseline (adjusted odds ratio 7·38, 1·73–31·50; p=0·0069).InterpretationOur findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services.FundingWellcome Trust, National Institute for Health Research.
Highlights
Many mental disorders emerge during adolescence and continue into adulthood.[1]
Among individuals with a diagnosed depressive disorder, adolescents are more likely than adults to delay contact with mental health services, thereby increasing episode duration and risk of recurrence
Among individuals with a disorder, 48 (38%) reported past-year service contact and 46 (96%) of these contacts were based on T1 past-year recall; 36 (84%) of 43 of these adolescents attended five or more sessions (n=5 had missing data for treatment length)
Summary
Many mental disorders emerge during adolescence and continue into adulthood.[1]. In depressive disorders, younger onset is associated with more depressive episodes, longer episode duration, increased comorbidity, suicidality, and admission to hospital.[2]. Early identification and treatment of mental disorders during adolescence would contribute to reduction and perhaps prevention of adverse sequelae. Measurement of the treatment gap—the discrepancy between disorder prevalence and proportion treated—is a prerequisite to enable policy makers to prevent such adverse sequelae from arising. Our review of international studies that report DSM-IV disorder and past-year contact with mental health services for those with a disorder (appendix pp 1, 2), found that 12–25% of adolescents have a mental disorder, of whom only 34–56% access mental health services. Previous surveys[3,4] in the UK report much higher proportions of contact with mental health services (71% of children or adolescents with a mental disorder); unlike most studies, these estimates classify seeking help from a teacher as a mental health service contact. Other studies[5,6] report 12–19% lower service use rates for anxiety than for depression
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