Rules versus Discretion: Treatment of Mental Illness in US Adolescents

• 成果类型: Article
• 署名作者: Cuddy, Emily; Currie, Janet
• 署名单位: Duke University; Princeton University; National Bureau of Economic Research
• 刊物名称: JOURNAL OF POLITICAL ECONOMY
• ISSN/ISSBN: 0022-3808
• DOI: 10.1086/738249
• 发表日期: 2026
• 关键词: health-care; regional-variations; CHILDREN; PEDIATRICIANS; PSYCHIATRISTS; medications; Shortage; outcomes; FAILURE; trauma

摘要

Many mental health disorders start in adolescence, and appropriate initial treatment may improve trajectories. But what is appropriate treatment? We use a large national database of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next 2 years, where treatment is either consistent with US Food and Drug Administration guidelines, consistent with looser guidelines published by professional societies (gray area prescribing), or inconsistent with any guidelines (red-flag prescribing). We find that red-flag prescribing increases self-harm, use of emergency rooms, and health care costs, suggesting that treatment guidelines effectively scale up good treatment in practice.