The American health care system segregates medical and mental health services, making for a flawed structure that limits health care access and the delivery of services.
A new study shows the dangerous implications of this separation as researchers found that suicidal teens are not likely to get the care they need.
The experts hope the finding will lead to more proactive screening by primary care specialists and improved identification of youth depression. Researchers believe care could then be provided by the primary care physician and/or the individual could be referred to a mental health specialist.
The team of researchers from Seattle Children’s Research Institute, the University of Washington (UW), and Group Health Research Institute have published their study in the journal Academic Pediatrics.
The investigators found that only 13 percent of teens with suicidal thoughts received mental health visits through their health care network and only 16 percent received services in the year after, despite being eligible for and having access to mental health care without a referral and with relatively small co-pays.
Mental health care was insufficient even when factoring in the care teens may receive from their primary care physician, as only 26 percent of teens with suicidal ideas in the study received services the year prior (including antidepressants and care received through an outside source).
“Teen suicide is a very real issue today in the United States. Until now, we’ve known very little about how much or how little suicidal teens use health care services. We found it particularly striking to observe such low rates of health care service use among most teens in our study,” said lead author Carolyn A. McCarty, Ph.D.
Sadly, suicide is the third leading cause of death for people aged 15 to 24 and the fourth leading cause of death for children between the ages of 10 and 14.
Identifying teens who have suicidal thoughts (suicidal ideation) is critical to preventing suicide. While many experts consider suicidal thoughts normative during adolescence, this study confirms teens with suicidal ideation experience more functional impairment such as interpersonal difficulties, school problems, and mental health problems.
Researchers in this study found these impairments persisted into a six-month follow-up period. These difficulties can, in turn, intensify the need for mental health care.
In the study, McCarty and co-investigators examined the use of health care services among teens aged 13-18 who were patients at Group Health Cooperative. A total of 198 teens were studied, including 99 teens who indicated they had had suicidal thoughts, and 99 control teens, matched on age and gender.
Administrative data spanning two years were collected from medical records, in addition to interviews conducted with teens and their parents.
Utilization of mental health services was low among both the control group and those with suicidal thoughts. Although 86 percent of the youths with suicidal ideation had seen a health care provider, only 13 percent had a mental health specialty visit, and only 7 percent received antidepressant medications.
Only 10 percent of those without suicidal ideation had received any mental health visits within the Group Health Cooperative system in the prior year.
However, respondents with suicidal ideation had significantly more severe depression, a greater prevalence of lifetime diagnosis of depression or anxiety, and higher scores of pediatric chronic disease.
When all mental health service questions were combined, 26 percent of the teens with suicide ideation received services the prior year, and 16 percent received services in the following year. These findings confirmed previous studies examining self-reported mental health services among adolescents.
“We know that asking teens about suicidal ideation does not worsen their problems,” said McCarty. “It’s absolutely crucial for a teen who is having thoughts of self-harm or significant depression to be able to tell a helpful, trustworthy adult.
“These findings underscore the need for clinicians to be aware of the potential for suicide in adolescence,” she added.
Primary care physicians and health care providers should be specifically assessing suicidal ideation in the context of depression screening for teenagers, McCarty said. Effective screening tools are available, as are effective treatments for depression.
Source: Seattle Children’s