OBJECTIVE:Childhood-onset psychiatric disorders can be persistent and impairing but often go untreated. Affected individuals' treatment utilization into adulthood is not well understood. A 15-year follow-up of depressed, anxious, and never mentally ill children (control group) examined need, predisposing, and enabling factors associated with use of outpatient mental health care into early adulthood. METHODS:Between 1977 and 1985, a total of 315 children and adolescents were ascertained. Their psychiatric status and treatment utilization into adulthood were reassessed between 1991 and 1997 by clinicians blind to their childhood diagnoses. RESULTS:Respondents ascertained for depression demonstrated 13-fold, and those ascertained for anxiety demonstrated six-fold, greater odds of any treatment compared with controls. Among utilizers, childhood depression conferred 14-fold, and childhood anxiety, 23-fold, increased odds of long-term treatment. Blacks were less likely than whites to obtain treatment. Utilizers older at follow-up reported longer treatment duration. Mood disorder episodes over follow-up and poorer global functioning were associated with both increased odds of any utilization and increased treatment duration among utilizers. CONCLUSIONS:This sample demonstrated high and persistent treatment utilization. Need indicated by childhood diagnosis was the strongest predictor of treatment; however, utilization also differed by race or ethnicity. Strategies to maximize the uptake of effective, culturally relevant treatment approaches should be investigated.