Essays in Youth Mental Health: Exploring Emergency Care, Policy Interventions, and Pandemic Challenges

Abstract

In this dissertation, I explore youth mental health and youth mental health services through three interrelated studies. In the first study, I examine the impact of inpatient psychiatric and residential care on children's and adolescents' healthcare service utilization following emergency department boarding. Analyses utilized matching techniques and augmented inverse probability weighting to estimate causal effects. Data included Massachusetts Medicaid and Children’s Health Insurance Program claims data from 2016 to 2019, obtained from the Transformed Medicaid Statistical Information System Analytic Files. I found that in the short term, inpatient admission after boarding significantly reduced return visits to emergency departments and subsequent psychiatric admissions. These findings highlight the importance of robust follow-up care after boarding for improving youth mental health outcomes and reducing the need for additional high-acuity care. In the second study, I utilize a stacked difference-in-difference approach to assess the impact of state bans on Sexual Orientation and Gender Identity Change Efforts (SOGICE), also known as conversion “therapies,” on youth mental health. Using data from the Youth Risk Behavior Survey (2011-2019), I found that bans led to significant and meaningful decreases in rates of seriously considering suicide among high school students. This evidence underscores the positive influence legislative bans can have on youth populations that are at increased risk for suicide. In the third study, my coauthors and I analyze trends in youth mental health care utilization during the COVID-19 pandemic, specifically emergency department visits, boarding durations, and inpatient admissions. Our analysis of national health insurance claims reveals increased ED visits, particularly among adolescent females, and a rise in prolonged boarding. This study highlights the urgent need to increase psychiatric resources across the care continuum to meet growing demands and reduce the strain on emergency departments. Together, these essays contribute to our understanding of how policies can impact mental health and consequences of having insufficient mental health resources to meet need, which can provide insight into how we can improve mental health and optimize care for children and adolescents.