Social and economic determinants of disparities in professional help-seeking for child mental health problems: evidence from a national sample.

OBJECTIVE

To test the role of social determinants-including race, education, income, and demographic factors-of child mental health services use, defined as having had a visit to a mental health professional for depression, attention-deficit, or for any reason.

DATA SOURCES/STUDY SETTING: National Longitudinal Survey of Youth and the Child/Young Adult supplement, a nationally representative sample of 7-14-year-old children born to women who were 14-22 years old at the start of data collection, in 1979. African Americans and Latinos were over-sampled, and population weights are available to make nationally representative inferences.

STUDY DESIGN

Indicators of mental health service use were regressed on social and economic determinants, family structure variables, and insurance variables, controlling for need as captured by several different symptom scales.

PRINCIPAL FINDINGS

Girls are much less likely to obtain needed treatment for externalizing behavior disorders than are boys, and are somewhat less likely to obtain needed treatment for depression than boys. Middle children are less likely to obtain needed treatment for any mental health problem than are oldest, youngest, or only children. The presence of the father inhibits the likelihood that the child will receive treatment, particularly for depression. African Americans and Latinos are less likely than white children to receive treatment. In contrast to these rich results for the social and demographic determinants of children's specialty mental health utilization, the economic and insurance variables (including maternal education and income) seem to hold little predictive power.

CONCLUSIONS

These results argue for interventions to sensitize parents-especially fathers-to the need to pay attention to the mental health needs of their children, in particular girls and middle children. The analysis also suggests that the literature on intrahousehold decision making and on the gender dimensions of investment in children is worth extending to mental health treatment decisions.