Do "Real World" Childhood Mental Health Services Reduce Risk for Adult Psychiatric Disorders?

Objective: This study tested the "intervention as prevention" hypothesis: that treatment of childhood psychopathology in the community might reduce risk for adult psychopathology. Method: Analyses were based on a prospective, population-based study of 1,420 children followed up to 8 times during childhood (ages 9-16 years; 6,674 observations) about psychiatric status and specialty mental health services use. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants) to assess adult psychopathology. Results: Participants with a childhood psychiatric disorder who used childhood specialty mental health services were at similar risk for adult emotional (odds ratio [OR] = 0.7; 95% CI = 0.3-1.4, p = .29) disorders and at higher risk for adult substance disorders (OR = 2.1; 95% CI = 1.1-4.2, p = .03) as compared those with a childhood disorder who did not use services. The risk for substance disorders was driven by children with behavioral disorders (OR = 3.6; 95% CI = 1.6-8.1, p = .002). Sensitivity analyses suggest that an unmeasured confounder would have to have an E value of 3.26 or risk ratio of 1.92 to alter this finding. Higher "dose" of services use (defined at 6+ visits) was not associated with improved outcomes. Conclusion: Community services use may reduce psychopathology within childhood, but they do not necessarily prevent adult psychiatric problems. These findings are consistent with the notion of mental health problems as chronic conditions that often begin in childhood but that may recur in different forms across the lifespan even when treated.