Objectives: Despite being recognized as a serious public health concern, suicidality among adolescents and young adults is frequently missed, and completed suicide remains the second leading cause of death for young Canadians. With such close links between depression, suicidality, and completed suicide, any intervention must address all 3 of these issues. However, to develop effective interventions, we must understand the types and rates of mental health service use among adolescents and young adults. This study examines service use rates in young Canadians with depression and suicidality and the influence of sex on the types of service provider chosen. Methods: We used data from the Canadian Community Health Survey: Mental Health and Weil-Being. Our sample included 619 individuals, aged 15 to 24 years, who screened positive for depression and suicidality in the past 12 months. We examined mental health service use rates in general and by provider type. Results: Among adolescents aged 15 to 18 years with depression, 40% had not used any mental health services. This rate was higher for adolescents with suicidality at 50%. In young adults aged 19 to 24 with depression, 42% had not used any mental health services. Among young adults with suicidality, 48% had not accessed services. Female adolescents and young adults were more likely to receive services from nonspecialty mental health providers. Conclusions: In Canada, many adolescents and young adults with depression and suicidality do not receive mental health services. Further, there may be a preferential treatment of young men by mental health specialists. Further research is needed to understand the quality of care received by these young Canadians and the factors influencing service use. (Can J Psychiatry 2007;52:228-232) Information on funding and support and author affiliations appears at the end of the article.
Clinical Implications • About 50% of adolescents and young adults with depression and suicidality do not use mental health services. • Strategies to increase service use in youth with depression are needed. • Strategies to decrease differences between the sexes in service use are needed. Limitations • The quality of care could not be examined from the CCHS 1.2 data. • The survey results were based on patient recall. • Although this was a national population-based study, the sample size was small.
• La Revue canadienne de psychiatrie, vol 52, no 4, avril 2007
Mental Health Service Use Among Adolescents and Young Adults With Major Depressive Disorder and Suicidality
Key Words: adolescents, depression, suicidality, service use, young adults
epression and suicidality (ideation and attempts) among adolescents and young adults are frequently unrecognized and untreated by any health professionals.' Not only are depression and suicidality often linked, but both pose a significant burden on patients and their families. Suicide is the second leading cause of death in youth aged 15 to 18 years, second only to motor vehicle accidents.^ Further, almost 50% of teens who complete suicide have a diagnosable mood disorder, such as depression, and have expressed suicidality prior to completing suicide.'^^ There are also consistent differences between male and female adolescents, with male adolescents more likely to complete suicide and female adolescents more likely to have depression and suicidality.^ Policy-makers, families, and providers have struggled to understand how to address this significant public health issue. A first step in addressing the issue is to understand the mental health service use pattems among adolescents and young adults with depression and suicidality. Given the differences in prevalence rates between young men and women, it is also critical to understand the influence of sex on...