Life Course Trajectories and Mental Health Outcomes Among High-Risk Youth: An Analysis of the National Longitudinal Survey of Youth 1997

Poor mental health is a significant contributor to mortality among 10-34 year olds with suicide deaths surpassing cardiovascular and cancer deaths (Centers for Disease Control & Prevention 2015). At this time we have little knowledge about the extent to which mental health policy interventions alter use of mental health treatment especially when evaluated over time in groups who are identified as high-risk for mental health problems in childhood (e.g. Sipe et al. 2015). The proposed study is responsive to the SDAS R40 mechanism and uses publiclyavailable population-based data from the National Longitudinal Survey of Youth 97 (NLSY97) to examine the contribution of social determinants of health in adolescence and the effect of state mental health policies on future mental health treatment in adulthood. We rely on the Life Course Health Development model to identify risk and protective factors which influence mental health and evaluate how system interventions (e.g. policies) mediate receipt of mental health treatment for these individuals. The outcome of this study will contribute to meeting the goals of Healthy People 2020 which aims to increase the proportion of children with mental health problems who receive treatment (MHMD-6) and Maternal and Child Health Bureau's Strategic Research Issue IV: Promoting the healthy development of MCH populations through the examination of how environments support maternal and child health. In this 1-year study we will: Aim 1: Create mental health risk groups of adolescents ages 12-16 at Time 1 (T1) based on individual family and environmental factors and evaluate group differences in future receipt of mental health treatment in adulthood of those who remain in the longitudinal sample 13-15 years after enrollment (T13 T14 T15). Aim 2: Estimate the impact of state mental health legislation on mental health treatment among adolescents with different levels of mental health risk exposure. We propose to use statistical tests and multivariate regression models to accomplish Aims 1 and 2 using a large nationally-weighted and diverse sample (n at T15= 7 423). We will use legal coding methods to develop two policy variables to be used in models: a) mental health policy strength; and b) exposure in months from policy to measurement of mental health treatment variable. These variables will be merged with the longitudinal data using state geocode to ensure individuals are represented by policy data. Innovative aspects of this study include the use of longitudinal data to answer whether the availability and quality of mental health legislation mediates receipt of mental health treatment in groups identified by their social determinants of health in adolescence. The findings from this project will inform upstream policy and community interventions to address the organization and delivery of mental health services for youth directly aligned with HRSA/MCHB's Strategic Plan.

Benevides TW, Carretta HJ, Graves KY, Sikka V. Emergency department use among young adult Medicare beneficiaries with autism and intellectual disabilities. Research in Autism Spectrum Disorders, Volume 70. DOI:10.1016/j.rasd.2019.101470 February 2020