The impact of early onset mental illness on income, health insurance status, and mental health service utilization in adulthood

Objective. To determine if adults who had early onset of a mental disorder differ from those with a late onset disorder with respect to income, health insurance status, and mental health service utilization.; Methods. Three analyses were conducted using data from the 1990-1992 National Comorbidity Survey. Adults aged 18-54 were categorized as having onset of a mental disorder prior to 16 years of age (n=1,415) or onset at age 16 years or older (n=1,262). Logistic, log-linear, and poisson regression were used to test for differences between age at onset and the outcome measures.; Results. Males with an early onset disorder were significantly more likely to be uninsured than males with a late onset disorder (OR=1.36; p=0.05). Household income was on average 6.8% lower for females with early onset versus females with late onset (p=0.01), while personal income was on average 27.5% lower (p<0.01). All significant associations were either partially or fully mediated by educational attainment. Adults with early onset were less likely to receive treatment from a health care professional, but among those who received care, early onset was associated with a higher likelihood of seeing a mental health specialist and a higher number of visits. There was no significant difference by age at onset in the likelihood of service use in a crisis-oriented setting. However, among the subset who received care in both crisis-oriented and ambulatory care settings, adults with early onset had 4 times as many visits.; Conclusions. These findings suggest that adults with an early onset disorder have significantly lower educational attainment than those with onset in adulthood and are less likely to have the financial and social resources that facilitate access to mental health services. Longitudinal research is needed to more fully understand the role of educational attainment on later income, health insurance, and access to mental health care for those with early onset mental illness. Intervention research would be most beneficial to determine whether individuals with onset before the age of 16 who receive help to finish high school and/or college or a trade school have outcomes comparable to those observed in this naturalistic study.