Advertisement

Prevention Science

, Volume 20, Issue 3, pp 366–376 | Cite as

Young Adult Mental Health: a Prospective Examination of Service Utilization, Perceived Unmet Service Needs, Attitudes, and Barriers to Service Use

  • Jennifer M. CadiganEmail author
  • Christine M. Lee
  • Mary E. Larimer
Article

Abstract

Most young adults with mental health symptoms do not receive treatment or access services. It remains important to identify barriers to service utilization to improve access to care. The current study was a prospective analysis examining predictors of (a) mental health service utilization and (b) perceived unmet need for mental health services. Barriers to service utilization were examined by prior depression severity status and college student status. Participants included a subsample of young adults ages 18–23 at time of recruitment who were participating in a longitudinal monthly study who completed both baseline and a 15-month follow-up assessment (N = 622, 80% of larger study). At month 15, 23% of young adults reported receiving mental health services in the past 12 months; 26% of young adults reported a perceived unmet need for mental health services at some point in the past 12 months. There were differences in demographic and mental health predictors of service utilization and perceived unmet need for services. Women, sexual minorities, those with moderate depression, those with more impairment from depression, and perceived past year poor mental health were associated with greater likelihood of receiving services. Similar demographic characteristics were associated with greater likelihood of perceiving unmet need for services. Barriers to service utilization differed by severity of depression symptoms and student status. Young adults have distinct reasons for not accessing mental health services; addressing these to improve accessibility to care remains critical.

Keywords

Young adults Mental health service utilization Depression Unmet service need 

Notes

Funding

Data collection and manuscript preparation was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (R01AA022087; PI: Lee). Manuscript preparation was also supported in part through NIAAA F32AA025263 (PI: Cadigan). The content of this manuscript is solely the responsibility of the author(s) and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.Google Scholar
  2. Adamson, S. J., Kay-Lambkin, F. J., Baker, A. L., Lewin, T. J., Thornton, L., Kelly, B. J., & Sellman, J. D. (2010). An improved brief measure of cannabis misuse: The cannabis use disorders identification test—revised (CUDIT-R). Drug and Alcohol Dependence, 110, 137–143.CrossRefGoogle Scholar
  3. APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271–285.CrossRefGoogle Scholar
  4. Arnett, J. J. (2007). Emerging adulthood: what is it, and what is it good for? Child Development Perspectives, 1, 68–73.CrossRefGoogle Scholar
  5. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., Monteiro, M. G., & World Health Organization. (2001). AUDIT: The alcohol use disorders identification test: Guidelines for use in primary health care.Google Scholar
  6. Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S. M., & Olfson, M. (2008). Mental health of college students and their non–college-attending peers: results from the national epidemiologic study on alcohol and related conditions. Archives of General Psychiatry, 65, 1429–1437.  https://doi.org/10.1001/archpsyc.65.12.1429 CrossRefGoogle Scholar
  7. Brent, D. A., Perper, J. A., Moritz, G., Allman, C., Friend, A. M. Y., Roth, C., et al. (1993). Psychiatric risk factors for adolescent suicide: a case-control study. Journal of the American Academy of Child & Adolescent Psychiatry, 32, 521–529.CrossRefGoogle Scholar
  8. Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371–377.CrossRefGoogle Scholar
  9. Burgess, D., Lee, R., Tran, A., & Van Ryn, M. (2008). Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons. Journal of LGBT Health Research, 3, 1–14.  https://doi.org/10.1080/15574090802226626 CrossRefGoogle Scholar
  10. Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70, 44–55.CrossRefGoogle Scholar
  11. Centers for Disease Control and Prevention (CDC). (2013). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. BRFSS. 2013 Behavioral Risk Factor Surveillance System Questionnaire.Google Scholar
  12. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.CrossRefGoogle Scholar
  13. Drum, D. J., Brownson, C., Denmark, A. B., & Smith, S. E. (2009). New data on the nature of suicidal crises in college students: shifting the paradigm. Professional Psychology: Research and Practice, 40, 213–222.  https://doi.org/10.1037/a0014465 CrossRefGoogle Scholar
  14. Dunbar, M. S., Sontag-Padilla, L., Ramchand, R., Seelam, R., & Stein, B. D. (2017). Mental health service utilization among lesbian, gay, bisexual, and questioning or queer college students. Journal of Adolescent Health.  https://doi.org/10.1016/j.jadohealth.2017.03.008
  15. Eisenberg, D., Hunt, J., & Speer, N. (2012). Help seeking for mental health on college campuses: review of evidence and next steps for research and practice. Harvard Review of Psychiatry, 20, 222–232.CrossRefGoogle Scholar
  16. Eisenberg, D., Hunt, J., Speer, N., & Zivin, K. (2011). Mental health service utilization among college students in the United States. The Journal of Nervous and Mental Disease, 199, 301–308.CrossRefGoogle Scholar
  17. Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007). Help-seeking and access to mental health care in a university student population. Medical Care, 45, 594–601.CrossRefGoogle Scholar
  18. Geisner, I. M., Neighbors, C., & Larimer, M. E. (2006). A randomized clinical trial of a brief, mailed intervention for symptoms of depression. Journal of Consulting and Clinical Psychology, 74, 393–399.  https://doi.org/10.1037/0022-006X.74.2.393 CrossRefGoogle Scholar
  19. Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., et al. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 61, 807–816.CrossRefGoogle Scholar
  20. Gonzalez, J. M., Alegria, M., & Prihada, T. J. (2005). How do attitudes toward mental health treatment vary by age, gender, and ethnicity/race in young adults? Journal of Community Psychology, 33, 611–629.  https://doi.org/10.1002/jcop.20071 CrossRefGoogle Scholar
  21. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10, 113.  https://doi.org/10.1186/1471-244X-10-113 CrossRefGoogle Scholar
  22. Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), 3–10.CrossRefGoogle Scholar
  23. Kahler, C. W., Strong, D. R., & Read, J. P. (2005). Toward efficient and comprehensive measurement of the alcohol problems continuum in college students: the brief young adult alcohol consequences questionnaire. Alcoholism: Clinical and Experimental Research, 29, 1180–1189.  https://doi.org/10.1097/01.ALC.0000171940.95813.A5 CrossRefGoogle Scholar
  24. Katz, D. S., & Davison, K. (2014). Community college student mental health: a comparative analysis. Community College Review, 42, 307–326.CrossRefGoogle Scholar
  25. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.  https://doi.org/10.1001/archpsyc.62.6.593 CrossRefGoogle Scholar
  26. Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32, 509–515.CrossRefGoogle Scholar
  27. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–616.  https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle Scholar
  28. Leaf, P. J., Livingston, M. M., Tischler, G. L., Weissman, M. M., Holzer III, C. E., & Myers, J. K. (1985). Contact with health professionals for the treatment of psychiatric and emotional problems. Medical Care, 23, 1322–1337.CrossRefGoogle Scholar
  29. Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980–989.CrossRefGoogle Scholar
  30. Pottick, K. J., Bilder, S., Vander Stoep, A., Warner, L. A., & Alvarez, M. F. (2008). US patterns of mental health service utilization for transition-age youth and young adults. The Journal of Behavioral Health Services and Research, 35, 373–389.CrossRefGoogle Scholar
  31. Schulenberg, J. E., & Maggs, J. L. (2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol, Supplement, 54-70.doi:  https://doi.org/10.15288/jsas.2002.s14.54.
  32. Sharp, M. L., Fear, N. T., Rona, R. J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews, 37, 144–162.CrossRefGoogle Scholar
  33. Sontag-Padilla, L., Woodbridge, M. W., Mendelsohn, J., D'Amico, E. J., Osilla, K. C., Jaycox, L. H., et al. (2016). Factors affecting mental health service utilization among California public college and university students. Psychiatric Services, 67, 890–897.CrossRefGoogle Scholar
  34. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.  https://doi.org/10.1001/archinte.166.10.1092 CrossRefGoogle Scholar
  35. Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744.CrossRefGoogle Scholar
  36. Substance Abuse and Mental Health Services Administration (SAMSHA). (2014). Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings, Rockville, MD. 2013 National Survey on Drug Use and Health: Mental Health Findings. NSDUH Series H-49, HHS Publication No. (SMA) 14–4887.Google Scholar
  37. Vogel, D. L., Wade, N. G., & Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53, 325–337.CrossRefGoogle Scholar
  38. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640.CrossRefGoogle Scholar
  39. Zivin, K., Eisenberg, D., Gollust, S. E., & Golberstein, E. (2009). Persistence of mental health problems and needs in a college student population. Journal of Affective Disorders, 117, 180–185.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA

Personalised recommendations