Longitudinal, Reciprocal Relations between Mental Health Service Utilization and Mental Health Symptoms

Background: Adolescence is often identified as the period of time when individuals first begin to experience mental health symptoms. Studies have consistently found that the majority of mental health needs first began during adolescence around the age of 14. Research suggests that mental health issues during adolescence increase the risk of persisting symptoms through adulthood and seeking mental health treatment early can decrease/prevent the risk of symptoms. To address a gap between needs and treatment accessibility, schools are becoming a primary location for youth to seek mental health services. This study aimed to examine longitudinal, reciprocal relationships between mental health service utilization and mental health symptoms from adolescence to adulthood: a) Does use of school-based or other mental health services predict subsequent use of mental health services?; b) will use of school-based mental health service or other mental health services predict subsequent depressive symptoms?; c) will depressive symptoms predict subsequent depressive symptoms?; and d) will depressive symptoms predict subsequent mental health service use?

Methods: Data came from the National Longitudinal Study of Adolescent Health (Add Health; N = 7,902). The majority of adolescents (average age=15) identified as female (59.1%) and White (67.6%) followed by Black (18.7%) and Hispanic (13.5%). We examined four waves of mental health service (MHS) utilization in the past 12 months and depressive symptoms (i.e., CES-D): school-based MHS in adolescence (T1); any other MHS and depression in adolescence (T1) and three time points in adulthood (T2-T4). We conducted cross-lagged panel analyses, adjusting for sociodemographic characteristics (e.g., age, race/ethnicity, sex, and income and insurance).

Results: First, school MHS utilization at Tn increased the odds of using MHS at Tn+1 across all waves (OR = 1.34, 1.53, and 1.61, respectively). Second, depressive symptoms at Tn also predicted depressive symptoms at Tn+1 (β = .21, .30, .30, respectively). Third, MHS use and depressive symptoms had reciprocal relationships. As MHS use at Tn predicted depressive symptoms at Tn+1 (β = .14 (school), .27, .11, .18, respectively), depressive symptoms at Tn were significantly related to future mental health service use at Tn+1 (OR = 1.09, 1.15, 1.05 respectively). Additionally, having limited income resources decreased odds of MHS use at T3 and was associated with increased depressive symptoms at T1, T3, and T4. Further significant results related to race/ethnicity, sex, and health insurance will be presented.

Discussion: The current study extends the understanding of the reciprocal relationship between MHS use and depressive symptoms. The study suggests the critical importance of using school-based services in adolescence to promote mental health service use in adulthood, highlighting implications for adolescent mental health service providers across service settings. Results also indicate the need for continued examination of longitudinal relations between service use and mental health symptoms and continued improvement of interventions to treat mental health needs.