Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes. We also found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: Overall, in the first 3 mo after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age. On average, these children are 12 y old. While the supply of mental health professionals impacts treatment choices, little of the overall variation is explained by supply-side variables, and at least half of the variation in treatment outcomes occurs within zip codes. These results suggest that other factors, such as physician practice style, may play an important role in the types of treatment that children receive.

许多精神健康疾病首先出现在青春期，早期治疗可能会影响病程。本研究利用大型国家保险索赔数据库，重点关注青少年患者在首次接受精神疾病治疗时所接受的护理类型的变化。我们发现，不同邮政编码的儿童接受后续护理的概率以及接受的后续护理类型存在很大差异。我们还发现，从治疗指南的角度来看，儿童接受药物治疗的概率存在很大差异，这会引发危险信号：总体而言，在首次声称患有精神疾病后的前 3 个月内，44.85% 的儿童接受药物治疗接受苯二氮卓类药物、三环类抗抑郁药或未经食品和药物管理局批准的适合其年龄的药物。这些孩子平均年龄12岁。虽然心理健康专业人员的供应会影响治疗选择，但总体变化几乎不能用供应方变量来解释，而且治疗结果的至少一半变化发生在邮政编码范围内。这些结果表明其他因素，例如医生的执业风格，可能在儿童接受的治疗类型中发挥重要作用。