Static, dynamic, integrated, and contextualized: A framework for understanding mental health service utilization among young adults Michelle R. Munson a, * , James Jaccard a , Susan E. Smalling b , Hyunsoo Kim b , James J. Werner c , Lionel D. Scott Jr. d a Silver School of Social Work, New York University, New York, USA b Mandel School of Applied Social Sciences, Case Western Reserve University, USA c Department of Family Medicine, Mandel School of Applied Social Sciences, Case Western Reserve University, USA d School of Social Work, Georgia State University, USA article info Article history: Available online 3 July 2012 Keywords: USA Theoretical framework Decision-making Mental health services Transition to adulthood Mood disorders Young adults abstract Research has illuminated the problem of untreated mental illness among young adults, including evidence that young people who exit public care systems often discontinue mental health services in adulthood. The present study explored mental health service use experiences during the transition to adulthood among sixty young adults, ages 18e25, from a Midwestern U.S. state. In-depth semi-struc- tured interviews were conducted. All participants had mood difficulties, and shared three childhood experiences: (a) mood disorder diagnosis; (b) use of public mental health services; and (c) experience with social service systems. Immersion and grounded theory coding techniques were applied to the interview data. Two major themes about mental health service use emerged from the findings, namely the changing nature of service use over time and characterizations of experiences associated with service use at a given point in time. Categories of explanatory constructs that emerged in the latter theme included perceived need, emotions, perceived efficacy of services, and social considerations, among others. Findings suggested a four-facet mid-level theory of service utilization, highlighting both the cross-sectional and time-variant character of service use and decision-making within context. Links between broader theoretical frameworks of service utilization and social psychological models of deci- sion making were noted, and guidelines were presented for ten classes of variables that researchers interested in understanding service use by young adults should consider. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Nationally representative epidemiological research indicates that 46% of the American adult population experiences at least one psychiatric disorder in their lifetime (Kessler et al., 2005), and 12- month prevalence rates of mood disorders are elevated among young adults when compared to older age cohorts (Kessler et al., 1994, 2009). Prevalence rates of mood disorders among “system youth,” defined as those who move in and out of mental health, child welfare, and juvenile justice systems (Osgood, Foster, Flanagan, & Ruth, 2005) are particularly high. A recent study by McMillen et al. (2005) reported a lifetime prevalence rate of 27% for major depression among a group of 17-year old youths in foster care, a rate higher than those found in the general populationdthat is, 16.8% (Newman et al., 1996). Treatment(s) for mood disorders have been shown to be relatively effective (AACAP, 2007), and the consequences of failing to treat can lead to psychosocial difficulties (Coryell et al., 1995). Individuals who receive publicly-funded children’s mental health care often experience abrupt discontinuation or, at best, fragmentation of services upon turning eighteen (i.e., See McMillen & Raghavan, 2009). This is of concern because research suggests that mental disorders are persistent and recurrent (Kim-Cohen et al., 2003). Thus, knowing (a) that young adulthood is a time of elevated need for but lack of receipt of treatment and (b) that mood disorders are associated with adverse young adult outcomes (i.e., Fergusson & Woodward, 2002), mental health service use (mental health service use, or simply ‘service use’) among vulnerable young adults is a pressing matter. Hence, this study was designed to explore in depth the service use experiences of young adults over the transition to young adulthood. Mental health service use theory Historically, research on service use has been guided by several useful broad based theories. The Sociobehavioral Model (Andersen, * Corresponding author. E-mail address: michelle.munson@nyu.edu (M.R. Munson). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.socscimed.2012.05.039 Social Science & Medicine 75 (2012) 1441e1449