Kataoka Sheryl H, Zhang Lily, Wells Kenneth B
Department of Psychiatry and Behavioral Sciences, Research Center on Managed Care for Psychiatric Disorders, University of California, Los Angeles, USA.
Am J Psychiatry. 2002 Sep;159(9):1548-55. doi: 10.1176/appi.ajp.159.9.1548.
Policy discussions regarding the mental health needs of children and adolescents emphasize a lack of use of mental health services among youth, but few national estimates are available. The authors use three national data sets and examine ethnic disparities in unmet need (defined as having a need for mental health evaluation but not using any services in a 1-year period) to provide such estimates.
The authors conducted secondary data analyses in three nationally representative household surveys fielded in 1996-1998: the National Health Interview Survey, the National Survey of American Families, and the Community Tracking Survey. They determined rates of mental health service use by children and adolescents 3-17 years of age and differences by ethnicity and insurance status. Among the children defined as in need of mental health services, defined by an estimator of mental health problems (selected items from the Child Behavior Checklist), they examined the association of unmet need with ethnicity and insurance status.
In a 12-month period, 2%-3% of children 3-5 years old and 6%-9% of children and adolescents 6-17 years old used mental health services. Of children and adolescents 6-17 years old who were defined as needing mental health services, nearly 80% did not receive mental health care. Controlling for other factors, the authors determined that the rate of unmet need was greater among Latino than white children and among uninsured than publicly insured children.
These findings reveal that most children who need a mental health evaluation do not receive services and that Latinos and the uninsured have especially high rates of unmet need relative to other children. Rates of use of mental health services are extremely low among preschool children. Research clarifying the reasons for high rates of unmet need in specific groups can help inform policy and clinical programs.
关于儿童和青少年心理健康需求的政策讨论强调青少年缺乏心理健康服务的使用，但全国范围内的相关估计数据较少。作者使用三个全国性数据集，研究未满足需求（定义为在一年期间有心理健康评估需求但未使用任何服务）方面的种族差异，以提供此类估计。
作者对1996 - 1998年进行的三项具有全国代表性的家庭调查进行了二次数据分析：全国健康访谈调查、美国家庭全国调查和社区追踪调查。他们确定了3至17岁儿童和青少年使用心理健康服务的比例以及种族和保险状况的差异。在被心理健康问题估计器（儿童行为检查表中的选定项目）定义为需要心理健康服务的儿童中，他们研究了未满足需求与种族和保险状况之间的关联。
在12个月期间，3至5岁儿童中有2% - 3%使用了心理健康服务，6至17岁儿童和青少年中有6% - 9%使用了心理健康服务。在被定义为需要心理健康服务的6至17岁儿童和青少年中，近80%没有接受心理健康护理。在控制其他因素后，作者确定拉丁裔儿童未满足需求的比例高于白人儿童，未参保儿童高于有公共保险的儿童。
这些发现表明，大多数需要心理健康评估的儿童没有接受服务，相对于其他儿童，拉丁裔和未参保儿童未满足需求的比例尤其高。学龄前儿童心理健康服务的使用率极低。阐明特定群体未满足需求率高的原因的研究有助于为政策和临床项目提供信息。
