Parent and teacher reports of problem behavior play an important role in recognizing a need for mental healthcare in adolescents, according to research published in the Journal of Clinical Psychiatry.

Researchers extracted data from the Dutch cohort study TRacking Adolescents’ Individual Lives Survey (TRAILS) and associated medical records from specialist mental healthcare organizations. Parent and teacher reports of internalizing and externalizing problems were assessed for adolescents at age 11, 13, 16, and 19. Self-reported problems were also captured at age 18. A total of 1478 adolescents were included in the study, 19.8% of whom had records with mental healthcare organizations.

After adjusting for sociodemographic covariates, researchers found that the tendency to internalize problems was more often associated with initial mental healthcare specialist use compared with externalizing problems. Teacher reports of problem behavior were more strongly associated with specialist care between the age of 11 and 13 (hazard ratio [HR], 1.57; 95% CI, 1.22-2.02; P <.001) compared with parent reports or self-reports. Between the age of 13 and 16, parent reports were most strongly predictive of specialist care (HR, 1.47; 95% CI, 1.13-1.91; P =.004). Self-reports were the primary predictive factor for specialist care for individuals age 16 to 19 (HR, 1.61; 95% CI, 1.25-2.08; P <.001) and 19 to 21 (HR, 1.50; 95% CI, 1.10-2.05; P =.011).

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These data emphasize the important role of parents and teachers in detecting mental health needs in adolescents. Researchers suggested that schools and parents continue to closely monitor adolescent behavior to allow for early intervention in any mental health conditions.  


Raven D, Jörg F, Visser E, et al. Predicting initial specialist mental health care use in adolescent using self-, parent-, and teacher-reported problem behavior: a prospective community-based record-linkage study. J Clin Psychiatry. 2018;79(4):17m11484.