Abstract: Youths Receiving Treatment in Community Mental Health Centers 2017 â€“ 2019: Anxiety, Depression, and High-Risk Substance Use (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)

Schedule:

Friday, January 12, 2024

Liberty Ballroom K, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Orrin Ware, PhD, MPH, MSW, Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Lisa Zerden, MSW, PhD, Associate Professor; Deputy Director for the UNC Behavioral Health Workforce Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

Jacquelynn Duron, PhD, Associate Professor, Rutgers University School of Social Work, New Brunswick, NJ

Yanfeng Xu, PhD, Assistant Professor, University of South Carolina, Columbia, SC

Lauren McCarthy, PhD, MSW, Postdoctoral Fellow, University of Colorado

Sarah Verbiest, DrPH, Clinical Associate Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Jenny Afkinich, PhD, MSW, Postdoctoral Fellow, University of North Carolina at Chapel Hill, Chapel Hill, NC

Qiana Brown, PhD, Assistant Professor, Rutgers University, New Brunswick, NJ

Denise Y. Williams, MSW, Doctoral Student, University of North Carolina at Chapel Hill, Chapel Hill, NC

Trenette Clark Goings, PhD, Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC

Background and Purpose

Anxiety and depressive disorders are two of the most common categories of mental health disorders impacting youths (ages ≤17). Approximately 1 in 10 youth have been diagnosed with an anxiety disorder and 1 in 20 with a depressive disorder in their lifetime. High-risk substance use (substance use that increases chances of harmful outcomes) and substance use disorders (SUDs) are often comorbid with mental health disorders. This study examined factors associated with high-risk substance use or SUDs among youths receiving treatment between 2017 to 2019 for an anxiety or depressive disorder.

Methods

We merged the 2017–2019 waves of the Substance Abuse and Mental Health Services Administration’s publicly available Mental Health Client-Level Data. This data set aggregates information about individuals receiving mental health treatment. Inclusion criteria were: (1) treatment from a community mental health center; (2) anxiety or depressive disorder as the primary diagnosis; (3) were youths (ages ≤17); and (4) received treatment in the U.S. Determined to be missing completely at random, we addressed missing data through listwise deletion. Our final analytic sample included 1,029,276 youths. Youths were mostly non-Hispanic white (53.6%), female (69.7%), and had a depressive disorder as their primary diagnosis (55.4%). Census region, age, gender, race and ethnicity, and the number of mental health diagnoses were included in two binary logistic regression models (1. youths with anxiety as their primary diagnosis; 2. youths with depression as their primary diagnosis) to assess the odds of having high-risk substance use or a SUD.

Results

Results from both logistic regression models indicated that receiving treatment in the Midwest, South, and West (vs. Northeast) was associated with increased odds (odds ratios [ORs] = 1.54–6.73, p < .001 for all) of having co-occurring high-risk substance use or a SUD. Conversely, being aged 0-11 and 12-14 (vs. 15-17) in both models was associated with lower odds (OR = 0.27-0.53, p <.001 for all). Having two or three mental health diagnoses (vs. one mental health diagnosis) was associated with increased odds (OR=1.22-1.88, p <.001 for all). Both models further showed that youths who were Hispanic or Latino of any race and “Other” race and ethnicity (vs. white) had increased odds of having co-occurring high-risk substance use or a SUD (OR=1.08-1.82, p <.001 for all). In the model, which included anxiety disorder as a primary diagnosis, Black (vs. white) youth had lower odds of having co-occurring high-risk substance use or a SUD (OR=0.92, p <.001).

Conclusions and Implications

Approximately 1 in 20 youths with an anxiety disorder and 1 in 10 youths with a depressive disorder in our sample also have high-risk substance use or a SUD, which are further associated with ecological and demographic factors functioning as correlates. These findings underscore the need for co-located mental health and substance use treatment services for youth, as well as the need to develop efficacious screening, diagnostic, and treatment approaches for youths with co-occurring mental health and SUD. Future research should examine associations by specific anxiety, depressive, and substance use disorders.