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Treatment Rates for Youth with Mental Disorders Are Consistently Low: International Study

November 23, 2023

November 22, 2023

Treatment rates worldwide are consistently low for children and adolescents with diagnosed mental disorders, according to an international study published by JAMA Open Network1 that showed significant variations in treatment by age, income level, and region.

The meta-analysis included data for 310,583 children across 40 studies from 1984 to 2017. The lowest combined treatment rate was reported for youth diagnosed with anxiety disorders (31% treated), followed by depressive disorders (36%), behavior disorders (49%), and ADHD (58%).

Timely treatment of common mental disorders reduces the risk of negative outcomes later in life, such as substance abuse. Despite rising global health concerns, mental disorders continue to go untreated for many children and teens. The severity of this issue is unclear because prevalence rates reported by published studies can vary widely, according to researchers. Combining data can help guide public health efforts and resources.

“Our findings provide important evidence for constructing evidence-based, targeted intervention policies and measures that aim to improve treatment rates for mental disorders among children and adolescents,” the researchers wrote.

Anxiety, Depression, and Age

The combined treatment rates for mood disorders varied significantly based on the age of participants. The proportion of children treated for anxiety disorders was more than three times higher than it was for adolescents. The inverse was true for depressive disorders; compared to children, more than three times as many adolescents with depression received treatment.

“The onset of childhood depression can be subtle: children may express irritability and frustration through tantrums and behavioral problems rather than verbally expressing their feelings,” the researchers wrote. But children with anxiety “are more prone to experiencing physical symptoms such as shortness of breath, headaches, stomach pain, and heart palpitations, which may prompt parents to seek assistance.”

In her recent ADDitude webinar on depression in teens, Karen Swartz, M.D., said that the onset of depressive symptoms is typically followed by an eight-year delay in getting treatment. The episodic nature of depressive disorders makes it easier to overlook. “You don’t have symptoms continuously that whole time. What you have is a period of symptoms and then it goes away, and then it comes back, and then it goes away, and then it comes back.”

“A teenage episode gets written off as being teenage angst,” she continued. “And then maybe a college episode, people will party through it and say, ‘Oh, you were just partying too much.’ So, it’s later when someone wants to focus on raising their family, keeping their job, doing those things, that they’ll get into treatment.”

Other Factors: Income Level and Region

Significant differences in depression and anxiety treatment rates were also found among income groups and regions. However, only high-income countries reported treatment rates for ADHD and behavior disorders. Cumulative social disadvantages and relative income poverty increase the risk of ADHD,2 underscoring the need for reporting practices and additional resources in countries and regions of relatively lower income.

“Compared with high-income countries, mental health services are severely underfunded in low- and middle-income countries: according to the World Health Organization 2020 Mental Health Atlas, government annual mental health expenditure per capita was $52.73 in high-income countries, compared with $3.29 in upper-middle-income countries and $0.08 in low-income countries.”

Treatment rates for depression were higher in the Americas than in Europe and the Western Pacific region, even when controlling for income. The researchers said that negative biases against people with mental disorders are common in Western European countries, citing an unwillingness by European adults to seek professional help for emotional distress (41% to 45%) compared to U.S. adults (23%).

Other common treatment barriers cited in the study include lack of public awareness, social stigma, costs, and logistical concerns. An ADDitude survey of 1,187 caregivers conducted in 2022 found scheduling conflicts, lack of accessibility, and long wait lists also influence access to and use of mental health services.

Limitations and Future Research

“Despite the consensus on the more hazardous effect of mental disorders on youths, compared with adults, the coverage of mental health services is inadequate,” the researchers said.

Future targeted interventions for youth were recommended:

  • Incorporating cultural factors when devising domestic intervention policies
  • At the government level, increasing allocation of mental health spending and public education in low- and middle-income countries
  • Consideration of proven interventions such as telemedicine options for patients and skills training for primary care providers

PubMed, Web of Science, PsycINFO, Scopus, and Embase were used to locate studies. The meta-analysis included 40 studies in total: 20 reported treatment rates for depressive disorders, 17 for “any mental disorder” (including anxiety disorders, mood disorders, impulse control disorders, and substance use disorders), 10 for ADHD, 9 for anxiety disorders, and 7 for behavior disorders. The combined treatment rate for “any mental disorder” was reported in the results. Girls accounted for 61% of participants. Children and adolescents were included if they had an existing diagnosis.

Caution should be taken when generalizing the results of the meta-analysis. The number of studies available varied across subgroups, which could compromise the representativeness of the sample. Other limitations included potential publication bias, and the exclusion of less common disorders including bipolar disorder, borderline personality disorder, and autism spectrum disorder.

Sources

1 Wang, S., Li, Q., Lu, J., et al. (2023). Treatment rates for mental disorders among children and adolescents: a systematic review and meta-analysis. JAMA Netw Open, 6(10), e2338174. doi:10.1001/jamanetworkopen.2023.38174

2Keilow, M., Wu, C., & Obel, C. (2020). Cumulative social disadvantage and risk of attention deficit hyperactivity disorder: Results from a nationwide cohort study. SSM Popul Health, 10, 100548. doi: 10.1016/j.ssmph.2020.100548. PMID: 32072007; PMCID: PMC7016018.

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