Objective: To examine factors associated with high intensity physician-based mental health care services in a population-based sample of children and youth in Ontario, Canada.
Methods: Data from the 2014 Ontario Child Health Study (OCHS) were linked at the person-level to longitudinal health administrative databases containing physician contacts in outpatient settings, emergency departments and hospitals. Our analytical sample (15.8% of 9,301, n = 1,423) included children and youth with at least one physician-based contact for a mental health concern in the 24-month period post-OCHS. Over the same follow-up period, we classified high intensity service use as those in the top 10th and fifth percentiles of physician-based mental health service cost contributors. Costs were assessed using physician billing data, as well as estimated emergency department visit and hospitalization costs.
Results: Among those with at least one contact, being older (PR: 1.15, 95% CI: 1.04, 1.25), having more severe symptoms of mental ill-health (PR: 1.04, 95% CI: 1.01, 1.06) and having a history of mental health service use (PR: 3.99, 95% CI: 1.37, 11.61), were positively associated with high-intensity service use, while living in a rural setting (PR: 0.35, 95% CI: 0.15, 0.30) was negatively associated. Findings were largely consistent between the top 10th and fifth percentiles. Notably, among youth ages 14-17 years, self-reported prior suicide attempt was positively associated with high-intensity (top fifth percentile) service use (PR: 6.09, 95% CI: 1.41, 26.26).
Conclusions: Our findings suggest older age, non-rural residency, mental health symptom severity and suicidal behaviour are important factors associated with high-intensity physician-based mental health service use. Our findings will inform efforts to better identify children and youth who may benefit from early and personalized interventions.
Keywords: child & youth; data linkage; high-intensity service use; mental health services.
Understanding Children and Youth with the Greatest Mental Health Related Service Needs.Plain Language SummaryWhy was the study done? There is a need to better understand children and youth who have the greatest mental health related service needs. Existing data gaps have limited our ability to identify important factors associated with children and youth with relatively high amounts of mental health service use. Our goal was to fill this knowledge gap by making use of multiple data sources, each capturing different information, that have been linked together. What did the researchers do? Data from the 2014 Ontario Child Health Study, a survey of 10,802 children and youth aged 4-17 years across Ontario, Canada, were linked at the person-level to health service records capturing information on all physicians, emergency departments, and hospitals, across the province. We identified children and youth with high service needs as those in the top 10th and fifth percentiles of costs related to service use in the 2-year period following completion of the survey. Costs were assessed using physician billing data, as well as estimated emergency department visit and hospitalization costs. What did the researchers find? We found that being older, having more severe symptoms of mental illness, and having a history of prior mental health service use were all positively associated with being identified in a high service needs group. We found that living in a rural area was negatively associated with being identified as having high service needs. We also found that among youth ages 14-17, self-reported suicide attempt was positively associated with being in a high service needs group. What do the findings mean? Our findings suggest older age, non-rural residency, mental health symptom severity, and suicidal behaviour are important factors associated with children and youth with the greatest mental health related service needs. This work will inform efforts to better identify children and youth who may benefit from early and personalized interventions.