0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

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

Mark Olfson, MD, MPH1; Carlos Blanco, MD, PhD1; Shuai Wang, PhD1; Gonzalo Laje, MD, MHSc2; Christoph U. Correll, MD3,4
[+] Author Affiliations
1Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York
2Maryland Institute of Neuroscience and Development, Chevy Chase
3Albert Einstein College of Medicine, Bronx, New York
4North Shore–Long Island Jewish Health System, Zucker Hillside Hospital, Glen Oaks, New York
JAMA Psychiatry. 2014;71(1):81-90. doi:10.1001/jamapsychiatry.2013.3074.
Text Size: A A A
Published online

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.

Objective  To assess national trends and patterns in the mental health care of children, adolescents, and adults in office-based medical practice.

Design, Setting, and Participants  Outpatient visits to physicians in office-based practice from the 1995-2010 National Ambulatory Medical Care Surveys (N = 446 542). Trends (1995-2010) in visits with mental health care indicators are first compared between youths (<21 years) and adults (≥21 years) and then between children (0-13 years) and adolescents (14-20 years). Background and clinical characteristics of recent visits (2007-2010) resulting in a mental disorder diagnosis are also compared among children, adolescents, and adults.

Main Outcomes and Measures  Visits resulting in mental disorder diagnoses, prescription of psychotropic medications, provision of psychotherapy, or psychiatrist care.

Results  Between 1995-1998 and 2007-2010, visits resulting in mental disorder diagnoses per 100 population increased significantly faster for youths (from 7.78 to 15.30 visits) than for adults (from 23.23 to 28.48 visits) (interaction: P < .001). Psychiatrist visits also increased significantly faster for youths (from 2.86 to 5.71 visits) than for adults (from 10.22 to 10.87 visits) (interaction: P < .001). Psychotropic medication visits increased at comparable rates for youths (from 8.35 to 17.12 visits) and adults (from 30.76 to 65.90 visits) (interaction: P = .13). While psychotherapy visits increased from 2.25 to 3.17 per 100 population for youths, they decreased from 8.37 to 6.36 for adults (interaction: P < .001). In 2007-2010, 27.4% of child visits, 47.9% of adolescent visits, and 36.6% of adult visits resulting in a mental disorder diagnosis were to a psychiatrist.

Conclusions and Relevance  Compared with adult mental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use. A great majority of mental health care in office-based medical practice to children, adolescents, and adults is provided by nonpsychiatrist physicians calling for increased consultation and communication between specialties.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Trends in Office-Based Medical Visits by Young People With Mental Disorder Diagnoses, 1995-2010

Analysis was limited to young people (≤20 years). The odds ratios (ORs) and 95% CIs for the study period are for disruptive behavior disorders (OR, 2.31 [95% CI, 1.78-2.99]), mood disorders (OR, 1.92 [95% CI, 1.40-2.64]), anxiety disorders (OR, 2.72 [95% CI, 1.71-4.32]), psychoses and developmental disorders (OR, 2.27 [95% CI, 1.44-3.59]), and other mental disorders (OR, 1.17 [95% CI, 0.87-1.57]). Data are from the National Ambulatory Medical Care Survey.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Trends in Office-Based Medical Visits by Young People With Psychotropic Medications, 1995-2010

The attention-deficit/hyperactivity disorder (ADHD) medications include stimulants, atomoxetine hydrochloride, guanfacine hydrochloride, and clonidine hydrochloride. The odds ratios (ORs) and 95% CIs for the study period are for ADHD mediations (OR, 4.13 [95% CI, 3.04-5.61]), anxioytics (OR, 1.28 [95% CI, 0.91-1.79]), antidepressants (OR, 1.60 [95% CI, 1.21-2.11]), antipsychotics (OR, 6.01 [95% CI, 3.90-9.26]), and mood stabilizers (OR, 1.92 [95% CI, 1.29-2.84]). Data are from the National Ambulatory Medical Care Survey.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 7

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();