The sample has been previously described (16
). Briefly, two-thirds of the sample is male (n=478, 68%) and White (n=455, 64%) with nearly half (n= 323, 45%) between the ages of six and eight. Fifty-two percent had public insurance and 23% of the children had a primary diagnosis within the bipolar spectrum. Sixty-three percent of the children had mild to moderate functional impairment and 72% had taken psychotropic medications during their lifetime.
Over 11% of the sample reported lifetime use of intensive services (n=80; ), most commonly inpatient hospitalization (n=64, 9%). Ninety-eight percent had used outpatient services with 58% (n=411) having consulted with a psychiatrist. School services (n=361, 51%) were most often special help in the regular classroom or counseling. Almost 50% of the sample had received both outpatient and school mental health services. The mean ages at which children began outpatient (M=6.3, SD=2.6) and alternative services (M=6.1, SD=2.8) were lower than intensive (M= 7.4, SD= 2.3) and school services (M=7.0, SD=2.1).
Lifetime Service Utilization by Modality & Mean Age Treatment Began
Demographic/ Clinical Variables and Service Utilization
Bivariate analyses () indicated that youth who were older, had lower CGAS scores and more than one diagnosis were more likely to be hospitalized. Older youth (i.e., aged 11–13) had more lifetime inpatient admissions and also had significantly more admissions in the last year. A higher percentage of older youth (n=32; 18%) had utilized both intensive and outpatient services during their lifetime compared to youth ages 6 to 8 (n=25, 8%) or 9 to 10 (n=21).
Service Utilization by Demographic Variables
For outpatient services, results indicated that youth were more likely to have had only therapy in their lifetime if they were non-white, female, younger and insured by Medicaid (). Analyses also indicated that youth were more likely to be receiving only medications at baseline if they were male and were higher functioning according to the CGAS. White children were more likely to have received both medications and therapy sometime in their life compared to other races as were older children and children not insured through Medicaid (χ2=14.02, p<.001). Children insured through Medicaid (n=88, 24%) were less likely to be utilizing two or more services compared to children with other coverage (n=113, 33.5%).
Multivariate results () indicated that, controlling for other demographic and clinical variables and consistent with the bivariate results, older children with lower CGAS scores were more likely to have ever been hospitalized. For treatment, receiving only therapy was related to being non-White, female, younger and insured by Medicaid while receiving only medication was more common if children were male (borderline) and had higher CGAS scores. Lifetime use of combination therapy was more common for older children, those not insured through Medicaid and those with lower CGAS scores.
Multivariate Results examining factors associated with Lifetime Inpatient Utilization and Outpatient Treatments
Diagnosis and Impairment Associations with Service Utilization
Across diagnostic categories, children diagnosed with bipolar spectrum disorder had the highest rates of lifetime inpatient admissions (n=36, 22%) and admissions in the past year (n=22, 14%) (). Across diagnostic categories, neither presence of comorbidity nor current level of functioning were significant factors for whether youth had lifetime or past year inpatient hospitalizations.
Service Utilization by Diagnosis & Level of Impairment
For outpatient services, in both the bipolar spectrum group and the depressive disorder group, more than half of the youth in each group had received both medication and therapy during their lifetime (bipolar: n=90, 57%; depressive: n=68, 55%). However among children in the disruptive behavior disorder group, more children had received therapy only (n=82, 40%) than both medication and therapy (n=75, 36%). Comorbidity and impairment did not impact lifetime exposure to different outpatient treatments with one exception. Children in the bipolar spectrum group with lower CGAS scores were more likely to have had only medication compared to those with higher scores. Also, youth with bipolar spectrum disorder and major functional impairment (n=32, 41%) were more likely to be utilizing at least two services than youth with bipolar spectrum disorder and mild impairment (n=21, 26%).
Characteristics and Benefits of Treatment as reported by parents?
Of those children who had at least one lifetime inpatient hospitalization (n=65, 9%), the mean number of hospitalizations was 2.3 (SD=3.1) (). Median length of stay for the most recent inpatient hospitalization was five days and the most frequently reported type of treatment was therapy only (n= 18, 28%) although many parents were unsure of treatments received (n= 20, 31%) or did not report any treatment (n= 11, 17%). Parents of children receiving medication only never reported their child benefited “a lot” from the treatment, and only 57% (n=4) reported their child benefited “some.”Most of the parents of children receiving therapy only or both medication and therapy reported their child benefited “some” or “a lot” from the treatment (therapy only: n= 17, 94%; combination: n= 8, 89%).
Characteristics and Benefit of Inpatient & Outpatient Service Utilization based on Caregiver Report
For current outpatient treatment, children were seeing, on average, 1.2 professionals (SD=0.8) and most often were receiving therapy only. Most parents of children receiving medication only or both medication and therapy reported their child benefited “some” or “a lot” from the treatment (medication only: n=156, 83%, combination: n=92, 84%). Fewer parents reported their child benefited “some” or “a lot” from therapy only (n= 165, 66%).