Adolescent Emotional/Behavioral Problems and Risk Behavior in Ontario Primary Care: Comorbidities and Costs
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It has been widely recognized that adult psychiatric problems are underrecognized, undertreated, and/or inappropriately diagnosed. Only recently has the Ontario Mental Health Supplement documented the prevalence of emotional/behavioral problems in youth 15 years and older. This study determined the prevalence, correlates, and costs of emotional/behavioral problems in 10- to 18-year-old youth enrolled in an urban middle class Canadian Health Service Organization (HSO) primary care setting. Some youth turned 19 during the course of the survey. A telephone survey of parents and youth was conducted on a random sample of 300 youth between the ages of 10 to 18 years enrolled in the HSO. The telephone survey used the National Institute of Mental Health Diagnostic Interview for Children (NIMH-DISC-Predictive Scale [DPS]) to measure the prevalence of emotional, behavioral problems. A mailed survey using the Youth Risk Behaviour Surveillance System (YRBSS) and a Health Service Utilization Questionnaire were returned by 180 of 300 youth. Over 38% of youth (10 to 18) reported one of five categories of behavior problems (excluding specific phobias such as snakes). Over 21.7% of reported youth had comorbid problems (from 2 to 5 of these categories: anxiety disorder, affective disorder, disruptive behavior disorder, substance abuse, and eating disorder). Most of the youth rated at high risk (N=70 of 72) declined the offer of a visit with their family physician. There was a positive relationship between intensity and type of youth risk behavior and the presence of emotional/behavioral problems. Despite declining the invitation to speak to their physician, youth with one or more emotional/behavioral problems had four times the total expenditures for use of all health and social services in the preceding 6 months compared to youth with no problems (p\textless.008). Youths with emotional/behavioral problems were particularly high users of family physician, public health, laboratory, emergency, and hospital services. There is an urgent need to identify and assist these youth who are high users of crises services because of their high-risk behaviors. Effective treatments require some combination of pharmacotherapy and counselling, especially for youth presenting to primary care or local emergency rooms for treatment of injuries. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
