Close to 30% of children in the US do not get any therapy within 3 months after a mental illness episode: Study

Almost half of the children who were prescribed medication for initial treatment either received strong, addictive drugs or pills that were not approved for child use by the FDA

                            Close to 30% of children in the US do not get any therapy within 3 months after a mental illness episode: Study
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Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease, say experts. However, researchers found that less than half of children in the US receive any therapy within three months after the first episode of mental illness. According to the analysis, 29.4% of children received no treatment in the three months following a mental illness episode, and 22.5% of children received only drug therapy. 

Only 5.86% of children received both drug treatment and therapy, which the team calls “surprising in view of current guidelines for adolescent mental health treatment.” Of the children receiving drugs, 45% were prescribed strong, addictive drugs in the benzodiazepine class (like Valium or Xanax), tricyclic antidepressants, or drugs that were not approved by the US Food and Drug Administration (FDA) for use in children as the first line of treatment. Compared with children who had pre-existing neurodevelopmental conditions, such as attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder, children without such conditions were more likely to be treated with these medications, reveals the study published in the Proceedings of the National Academy of Sciences (PNAS). Children whose initial mental illness claim included a hospital visit were more likely than other children to receive medication. 

The findings occur even in areas that are relatively well served by child psychiatrists, suggesting that they are not simply the result of doctor shortages, emphasizes the team. According to the investigators, this indicates that variation in clinical practice is an important factor in the type of mental health treatment children receive.

“If children are receiving sub-standard care, a shortage of doctors in that area is often to blame. However, we find a lot of differences in the way children are treated after the first episode of mental illness regardless of ZIP code. What this says is that some individual doctors could be making questionable treatment decisions, and this should be a red flag to those in the medical community,” explains study co-author Janet M Currie, the Henry Putnam professor of economics and public affairs at Princeton University and co-director of Princeton’s Center for Health and Wellbeing.

Using a national database of insurance claims, the authors investigated the type of treatment adolescents received after the first episode of mental illness. Of the more than 2 million children covered in this dataset, there were 202,066 with at least one claim related to mental illness. The analysis reviewed privately insured children with at least one mental illness claim between the ages of 11 and 18 years. Girls were more likely than boys to have claims. On average, children were 12 years of age when their first mental illness claim was filed, and they were suffering from anxiety or depression. 

The findings occur even in ZIP codes that are relatively well served by child psychiatrists, suggesting that they are not simply the result of doctor shortages. (Egan Jimenez, Princeton University)

The researchers zeroed in on an adolescent’s first mental health claim, which reflects children who were hospitalized or treated in the emergency room for incidents like suicide attempts, self- harm, suicidal ideation, or panic attacks. They also looked at children who received an in-depth evaluation of their mental health condition, as there are relatively clear guidelines on how these children should be treated by doctors. 

The analysis reveals that mental illness treatment varies widely among American adolescents within and across zip codes. Common medical advice suggests children receive prompt follow-up treatment, which is why the authors analyzed treatment within three months after the first incident. When drugs are thought to be necessary, those in the Selective Serotonin Reuptake Inhibitors (SSRIs) class are typically recommended by physicians as first-line treatments for anxiety and depression, as most children tolerate them well, explains the team. But, what they found was startling: only 70.8% of children received any follow-up treatment at all in the first three months, and this varied widely. Depending on the ZIP code, this ranged from 50% to over 90%.

Many children received only medication, even though it is generally considered appropriate to begin with therapy alone or to combine drug treatment and therapy. Again, this varied across ZIP codes, from 17% to 62%. “Nearly half of the children who were given drugs were prescribed drugs with more severe potential side effects and little to no evidence of effectiveness in children,” the findings reveal. 

According to Currie, while as researchers they cannot say that any given child should not have received a particular drug, the findings were nonetheless disturbing, especially the variation within and across areas. “Even in places that are well supplied with mental health professionals, we see very similar patterns, and that is concerning when it comes to caring,” writes Currie.

Based on their findings, the investigators suggest that some clinicians do not follow broadly agreed-upon general guidelines for the treatment of children with newly diagnosed mental health disorders. They recommend further research to understand the reasons for these patterns and their impact on the affected children. “Good mental health is tremendously important for children's futures. We hope that by highlighting these patterns, we can help to start a dialog that leads to better mental healthcare for children. If clinicians aren’t following guidelines, it is important to know whether this reflects their training or other factors, and how the care available to children with mental health issues can be improved,” concludes the team.

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