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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

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Characterizing the unmet mental health needs of urban adolescents

Priyanka Joshi / Monika LemkeORCID iD: https://orcid.org/0000-0003-3007-0897
  • Corresponding author
  • Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
  • Children’s National Medical Center, Division of Adolescent and Young Adult Medicine, 111 Michigan Ave., N.W., Washington, DC 20010, United States of America
  • orcid.org/0000-0003-3007-0897
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Lisa K. Tuchman
  • Children’s National Medical Center, Division of Adolescent and Young Adult Medicine, Washington, DC 20010, United States of America
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-02-23 | DOI: https://doi.org/10.1515/ijamh-2018-0258



Untreated mental illness among adolescents is a serious public health concern. This study offers a classification tool for mental illness based on severity and identifies a starting point for needed interventions.


We assessed the prevalence and severity of serious emotional disturbances (SED)/serious mental illnesses (SMI) among transition-aged adolescents in an urban primary care practice and identified those with unmet needs. Medical records were abstracted for 16–22 year-old patients with at least one International Classification of Diseases (ICD)-9 diagnosis of serious emotional disturbances (SED)/serious mental illnesses (SMI) seen between May 1, 2014 and July 31, 2015. The primary outcome was whether 16–22 year-old patients with serious emotional disturbances (SED)/serious mental illnesses (SMI) diagnoses were connected to mental health care and associated factors including severity of mental illness, provider referral and psychotropic medication use.


We identified 546 patients with a mean age of 18.8 years [standard deviation (SD) ± 1.7]. Ninety percent were African American and 86% were publicly insured. Based on the illness severity criteria, 189 (35%) were categorized as “mild”, 293 (54%) as “moderate” and 64 (12%) as “severe”. The majority (n = 460, 84.3%) had a mental health referral, but only 219 (40%) were connected to care. Adolescents aged 18–22 had 48% fewer odds to be connected to care compared to those aged 16–17 (odds ratio, 0.52; 95% confidence interval, 0.34–0.80; p-value = 0.003).


There is a gap in mental health services among a sample of minority adolescents in an urban environment with mental health needs. The gap is especially prevalent among older adolescents aging out of the pediatric system. Primary care providers (PCPs) are central to ensuring access to treatment, though they may be unable to meet the needs of patients with severe forms of serious emotional disturbances (SED)/serious mental illnesses (SMI). Our study characterizes the mental health needs of minority adolescents by severity and offers direction for identifying those who would most benefit from additional resources and support.

Keywords: connection to care; mental health severity; mental illness; transition-aged adolescents; transition of care


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About the article

Received: 2018-11-14

Accepted: 2019-01-22

Published Online: 2019-02-23

Funding source: No funding was secured for this study.

Financial disclosure: The authors have no financial disclosures relevant to this article to disclose.

Conflict of interest: The authors have no conflicts of interest relevant to this article to disclose.

Contributor’s statement: Dr. Tuchman conceptualized and designed the study, drafted the initial manuscript and reviewed and revised the manuscript. Dr. Joshi conceptualized and designed the study, designed the data collection instruments, collected data and drafted and critically revised the manuscript. Ms. Lemke carried out the analyses and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Citation Information: International Journal of Adolescent Medicine and Health, 20180258, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2018-0258.

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