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Child Anxiety Disorders in Public Systems of Care: Comorbidity and Service Utilization

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Abstract

Little is known about mental health service use among children with anxiety disorders, and even less is known about these children in public sectors of care. In this study, 1,715 children were randomly sampled from one of five public service systems. Psychiatric diagnoses were assessed with a structured interview, and standardized measures were used to assess mental health service utilization. Data from a subsample (n = 779) of youth with psychiatric disorders were analyzed. Analyses revealed that comorbidity among children with anxiety disorders was substantially higher than general population estimates. Approximately 26% of children with anxiety had a comorbid mood disorder, and 62% had a disruptive behavior disorder. Among children with anxiety disorders, those who had comorbid conditions were more likely to receive inpatient services than those without comorbidity. Comorbidity, caregiver strain, and service sector were associated with inpatient and nonspecialty service use in this group. Findings underscore the substantial comorbidity among children with anxiety disorders in public sectors of care and the potential need to adapt evidence-based interventions to meet the complex and multiple needs of these children.

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References

  1. 1.

    Essau CA, Conradt J, Petermann F. Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents. Journal of Anxiety Disorders. 2000;14:263–279 doi:10.1016/S0887-6185(99)00039-0.

  2. 2.

    Reinherz HZ, Giaconia RM, Lefkowitz ES, et al. Prevalence of psychiatric disorders in a community population of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32:369–377.

  3. 3.

    Wittchen H-U, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological Medicine. 1998;28:109–126 doi:10.1017/S0033291797005928.

  4. 4.

    Dorn LD, Campo JC, Thato S, et al. Psychological comorbidity and stress reactivity in children and adolescents with recurrent abdominal pain and anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42:66–75 doi:10.1097/00004583-200301000-00012.

  5. 5.

    Stein MB, Fuetsch M, Mueller N, et al. Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry. 2001;58:251–256 doi:10.1001/archpsyc.58.3.251.

  6. 6.

    Fordham K, Stevenson-Hinde J. Shyness, friendship quality, and adjustment during middle childhood. Journal of Child Psychology and Psychiatry. 1999;40:757–768 doi:10.1017/S0021963099004072.

  7. 7.

    Livingston R, Taylor J, Lynn Crawford SL. A study of somatic complaints and psychiatric diagnosis in children. Journal of the American Academy of Child and Adolescent Psychiatry. 1988;27:185–187 doi:10.1097/00004583-198803000-00009.

  8. 8.

    Van Ameringen M, Mancini C, Farvolden P. The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders. 2003;17:561–571 doi:10.1016/S0887-6185(02)00228-1.

  9. 9.

    Woodward LJ, Fergusson DM. Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:1086–1093 doi:10.1097/00004583-200109000-00018.

  10. 10.

    Essau CA, Conradt J, Petermann F. Course and outcome of anxiety disorders in adolescents. Journal of Anxiety Disorders. 2002;16:67–81 doi:10.1016/S0887-6185(01)00091-3.

  11. 11.

    Pine DS, Cohen P, Gurley D, et al. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry. 1998;55:56–64 doi:10.1001/archpsyc.55.1.56.

  12. 12.

    Chavira DA, Stein MB, Bailey K, et al. Childhood Anxiety Disorders in Primary care; Prevalent but untreated. Depression and Anxiety. 2004;20:155–164 doi:10.1002/da.20039.

  13. 13.

    Essau CA. Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders. Depression and Anxiety. 2005;22:130–137 doi:10.1002/da.20115.

  14. 14.

    Keller MB, Lavori PW, Wunder J, et al. Chronic course of anxiety disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 1992;31:595–599.

  15. 15.

    Garland AF, Hough RL, McCabe KM, et al. Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:409–418 doi:10.1097/00004583-200104000-00009.

  16. 16.

    Garland AF, Hough R, Landsverk J, et al. Multi-sector complexity of systems of care for youth with mental health needs. Children’s Services: Social Policy, Research and Practice. 2001;4:123–140 doi:10.1207/S15326918CS0403_2.

  17. 17.

    Glisson C, Hemmelgarn A. The effects of organizational climate and interorganizational coordination on the quality and outcomes of children’s service systems. Child Abuse and Neglect. 1998;22:401–421 doi:10.1016/S0145-2134(98)00005-2.

  18. 18.

    Garland AF, Lau AS, Yeh M, et al. Racial and ethnic utilization of mental health services among high-risk youths. American Journal of Psychiatry. 2005;162:1336–1143 doi:10.1176/appi.ajp.162.7.1336.

  19. 19.

    Hough RL, Hazen AL, Soriano FI, et al. Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services. 2002;53:1556–1562 doi:10.1176/appi.ps.53.12.1556.

  20. 20.

    Goodman E, Amick BC, Rezendes MO, et al. Influences of gender and social class on adolescents’ perceptions of health. Archives of Pediatric and Adolescent Medicine. 1997;151:899–904.

  21. 21.

    Kataoka SH, Zhang L, Wells KB. Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry. 2002;159:1548–1555 doi:10.1176/appi.ajp.159.9.1548.

  22. 22.

    McCabe K, Yeh M, Hough RL, et al. Racial/ethnic representation across five public sectors of care for youth. Journal of Emotional and Behavior Disorders. 1999;7:72–79 doi:10.1177/106342669900700202.

  23. 23.

    Yeh M, McCabe K, Hurlburt M, et al. Referral sources, diagnoses, and service types of youth in public outpatient mental health care: a focus on ethnic minorities. Journal of Behavioral Health Services Research. 2002;29:45–60 doi:10.1007/BF02287831.

  24. 24.

    Leslie LK, Weckerly J, Landsverk J, et al. Racial/ethnic differences in the use of psychotropic medication in high-risk children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 2003;42:1433–1442 doi:10.1097/00004583-200312000-00010.

  25. 25.

    Alegria M, Canino G, Lai S, et al. Understanding caregivers’ help-seeking for Latino children’s mental health care use. Medical Care. 2004;42:447–455 doi:10.1097/01.mlr.0000124248.64190.56.

  26. 26.

    Angold A, Messer SC, Stangl D, et al. Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health. 1998;88:75–80.

  27. 27.

    Anderson RM. Revisiting the behavioral model and access to medical care; does it matter? Journal of Health and Social Behavior. 1995;36:1–10 doi:10.2307/2137284.

  28. 28.

    Aarons G, Brown S, Hough R, et al. Prevalence of substance use disorders among adolescents in public sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:419–426 doi:10.1097/00004583-200104000-00010.

  29. 29.

    Shaffer D, Fisher P, Lucas CP, et al. NIMH Diagnostic Interview Schedule for Children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry. 2000;39:28–38 doi:10.1097/00004583-200001000-00014.

  30. 30.

    Cantwell DP, Lewinsohn PM, Rhode P, et al. Correspondence between adolescent report and parent report of psychiatric diagnostic data. Journal of the American Academy of Child and Adolescent Psychiatry. 1996;36:610–619.

  31. 31.

    Shaffer D, Gould MS, Brasic J. Children’s global assessment scale (CGAS). Archives of General Psychiatry. 1983;40:1228–1231.

  32. 32.

    Leaf PJ, Alegria M, Cohen P, et al. Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry. 1996;35:889–897 doi:10.1097/00004583-199607000-00014.

  33. 33.

    Brannan AM, Heflinger GA, Bickman L. The caregiver strain questionnaire: Measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavior Disorders. 1997;5:212–222.

  34. 34.

    Horwitz SM, Hoagwood K, Stiffman AR, et al. Reliability of the services assessment for children and adolescents. Psychiatric Services. 2001;52:1088–1094 doi:10.1176/appi.ps.52.8.1088.

  35. 35.

    Hazen AL, Hough RL, Landsverk JA, et al. Use of mental health services by youths in public sectors of care. Mental Health Services Research. 2004;6:213–226 doi:10.1023/B:MHSR.0000044747.54525.36.

  36. 36.

    SPSS for Windows, Rel. 14.0.2, Chicago: SPSS Inc., 2006.

  37. 37.

    Angold A, Costello EJ, Erkanli A. Comorbidity. Journal of Child Psychology and Psychiatry. 1999;40:57–87 doi:10.1017/S0021963098003448.

  38. 38.

    Bowen R, Chavira DA, Bailey K, et al. Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting. Psychiatry Research. 2008;157:201–209 doi:10.1016/j.psychres.2004.12.015.

  39. 39.

    Essau CA. Comorbidity of anxiety disorders in adolescents. Depression and Anxiety. 2003;18:1–6 doi:10.1002/da.10107.

  40. 40.

    March JS, Swanson JM, Arnold LE, et al. Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA). Journal of Abnormal Child Psychology. 2000;28:527–541 doi:10.1023/A:1005179014321.

  41. 41.

    Tannock R. Attention-deficit/Hyperactivity disorders with anxiety disorders. In: Brown T, ed. Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults. Washington, DC: American Psychiatric; 2000:125–170.

  42. 42.

    Stein MB, Fuetsch M, Muller N, et al. Social anxiety disorder and the risk of depression. Archives of General Psychiatry. 2001;58:251–256 doi:10.1001/archpsyc.58.3.251.

  43. 43.

    Biederman J, Faraone SV, Chen WJ. Social Adjustment Inventory for children and adolescents: concurrent validity in ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry. 1993;32:1059–1064.

  44. 44.

    Greene RW, Biederman J, Faraone SV, et al. Social impairment in girls with ADHD: patterns, gender comparisons, and correlates. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:704–710 doi:10.1097/00004583-200106000-00016.

  45. 45.

    Slomkowski C, Klein RG, Mannuzza S. Is self-esteem an important outcome in hyperactive children? Journal of Abnormal Child Psychology. 1995;23:303–315 doi:10.1007/BF01447559.

  46. 46.

    Boden JM, Fergusson DM, Horwood LJ. Anxiety disorders and suicidal behaviors in adolescence and young adulthood: findings from a longitudinal study. Psychological Medicine. 2006;37:431–440 doi:10.1017/S0033291706009147.

  47. 47.

    Biederman J, Faraone S, Milberger S, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry. 1996;53:437–446.

  48. 48.

    Jensen PS, Hinshaw SP, Kraemer HC, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:147–158 doi:10.1097/00004583-200102000-00009.

  49. 49.

    Newcorn JH, Miller SR, Ivanova I, et al. Adolescent outcome of ADHD: impact of childhood conduct and anxiety disorders. CNS Spectrums. 2004;9:668–678.

  50. 50.

    Pliszka SR. Effect of anxiety on cognition, behavior, and stimulant response in ADHD. Journal of the American Academy of Child and Adolescent Psychiatry. 1989;28:882–887 doi:10.1097/00004583-198911000-00012.

  51. 51.

    DuPaul GJ, Barkley RA, McMurray MB. Response of children with ADHD to methylphenidate: interaction with internalizing symptoms. Journal of the American Academy of Child and Adolescent Psychiatry. 1994;3:894–903.

  52. 52.

    Newcorn JH, Halperin JM, Jensen PS, et al. Symptom profiles in children with ADHD: effects of comorbidity and gender. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:137–146 doi:10.1097/00004583-200102000-00008.

  53. 53.

    Gadow KD, Nolan EE, Sverd J, et al. Anxiety and depression symptoms and response to methylphenidate in children with attention-deficit hyperactivity disorder and tic disorder. Journal of Clinical Psychopharmacology. 2002;22:267–274 doi:10.1097/00004714-200206000-00007.

  54. 54.

    Hinshaw SP. Moderators and mediators of treatment outcome for youth with ADHD: understanding for whom and how interventions work. Ambulatory Pediatrics. 2006;7:91–100 doi:10.1016/j.ambp.2006.04.012.

  55. 55.

    Garralda ME, Bailey D. Child and family factors associated with referral to child psychiatrists. British Journal of Psychiatry. 1988;153:81–89.

  56. 56.

    Woodward L, Dowdney L, Taylor E. Child and family factors influencing the clinical referral of children with hyperactivity: A research note. Journal of Child Psychology and Psychiatry. 1997;38:479–485 doi:10.1111/j.1469-7610.1997.tb01533.x.

  57. 57.

    Zahner GE, Daskalakis C. Factors associated with mental health, general health, and school-based service use for child psychopathology. American Journal of Public Health. 1997;87:1440–1448.

  58. 58.

    Weiss B, Harris V, Catron T, et al. Efficacy of the RECAP intervention program for children with concurrent internalizing and externalizing problems. Journal of Consulting and Clinical Psychology. 2003;71:364–374 doi:10.1037/0022-006X.71.2.364.

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Acknowledgements

This research was supported by NIMH grant U01 MH55282 to Dr. Hough and NIMH MH072952 to Dr. Chavira.

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Correspondence to Denise A. Chavira PhD.

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Chavira, D.A., Garland, A., Yeh, M. et al. Child Anxiety Disorders in Public Systems of Care: Comorbidity and Service Utilization. J Behav Health Serv Res 36, 492–504 (2009). https://doi.org/10.1007/s11414-008-9139-x

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Keywords

  • children
  • anxiety
  • mental health services
  • comorbidity
  • public sector