1. Mental Healthcare Utilization as Adolescents Become Young Adults Jennifer W. Yu, Sc.D. Sally H. Adams, Ph.D. Claire Brindis, Dr.P.H. Charles E. Irwin, Jr., M.D. University of California, San Francisco AcademyHealth Annual Meeting June 27, 2006

2. Background Young adults (ages 18 to mid-20’s) constitute a unique population with regards to mental health Mental health problems in adolescence not only persist into young adulthood, but may become exacerbated if left untreated earlier in life –Mortality due to suicide is almost three times greater among young adults than adolescents (CDC, 2005)

3. Background There is a paucity of literature on mental healthcare for young adults Children and adolescents have high rates of unmet mental health needs, despite existing support systems Young adults face numerous barriers to accessing appropriate medical care –Gaps in insurance coverage (Callahan & Cooper, 2005) –The transitional nature of young adulthood makes it difficult to establish appropriate support systems (Park, et al., in press)

4. Research Objectives Compare rates of mental health service (MHS) utilization between adolescents and young adults Determine predictors of MHS use for young adults Identify reasons for foregone care among those with mental health needs in young adulthood

5. The National Longitudinal Study of Adolescent Health (Add Health) 132 schools across the US, stratified by size, school type, census region, level of urbanization, percent white 1995 Wave 1 N = 20,745 Ages 12-19 1996 Wave 2 N = 14,738 Ages 13-21 2001 Wave 3 N = 12,000 Ages 18-26 (n=10,817)

6. Objective 1: Rates of MHS use during Adolescence and Young Adulthood (n=10,817) Adolescent % Young Adult % Difference % Total Population11.56.94.6* *p<0.001

7. Objective 1: Rates of MHS use during Adolescence and Young Adulthood Adolescent % (n) Young Adult % (n) Difference % Total Population11.56.94.6* Mental Health Subgroups Mild to Severe Depressive Symptoms 1 21.4 (2761) 15.1 (2176) 6.3* Suicidal ideation23.9 (1020) 22.5 (481) 1.4 Suicide attempt40.3 (257) 40.6 (100) -0.3 Suicide multiple attempts41.7 (147) 37.9 (65) 3.8 *p<0.001 1 Measured by the CES-D scale

8. Objective 2 Determine predictors of MHS use for young adults Methods –Logistic regression analysis of sociodemographic, adolescent (Wave 1), and young adult (Wave 3) variables predicting MHS utilization in young adulthood Dependent Variable –747 (6.9%) participants received MHS during young adulthood

9. Predictors of MHS use in Young Adulthood CharacteristicsMultivariate Odds Ratio 95% CI Black0.57(1.10-1.77) Current school attendance1.48(1.05-2.09) Routine physical exam1.58(1.16-2.15) Female1.71(1.23-2.37) Maternal ed: highest2.17(1.21-3.88) Mental health problems3.62(2.58-5.07)

10. Objective 3 Identify reasons for foregone care among those with mental health needs in young adulthood Foregone Care: Was there a time in the past 12 months when you should have received care, but did not receive it? –Mental Health Need (n=402) Had a problem related to severe stress, depression, or nervousness –Other Health Need (n=2,122) E.g. Injury during a physical fight, felt sick or had symptoms of a health problem

11. Add Health Items: Reasons for Foregone Care Access Problems –E.g., Couldn’t pay, No transportation, Didn’t know whom to see Non-Access Problems –E.g., Thought the problem would go away, Too embarrassed, Didn’t think the doctor could help

12. Foregone Care: Access Reasons * *p<0.01

13. Foregone Care: Non-Access Reasons * * *p<0.01

14. Summary Young adults reported lower rates of MHS use compared to adolescents Significant sociodemographic variables –Female gender and high maternal education increased MHS use –Black race decreased MHS use in young adulthood Significant young adult (Wave 3) variables –Attending school, receiving routine physical exams, and experiencing mental health problems

15. Summary Both young adults with mental and other healthcare needs identify similar reasons for foregone care However, young adults who forego mental healthcare cited inability to pay and concerns regarding physician’s care significantly more often than those who forego other healthcare

16. Conclusions Unmet mental health needs continue to exist in young adulthood, particularly among individuals with depressive symptomology. Blacks and males as specific populations that are less likely to utilize MHS. Health insurance does not play a role in MHS utilization, perhaps because many health plans do not provide significant MH coverage. Physicians’ awareness of their role can help promote MHS use in young adults.

17. Acknowledgements Agency for Healthcare Research and Quality (5 T32 HS000086) Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services (U45MC 00023). This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (addhealth@unc.edu).