Department of Community Health and Social Medicine, School of Medicine, City University of New York, New York, NY, United States.
American Educational Research Association, Washington, DC, United States.
Front Public Health. 2021 Mar 8;9:641605. doi: 10.3389/fpubh.2021.641605. eCollection 2021.
Mental disorders represent serious public health concerns in the U.S. Compared with Whites, racial/ethnic minority adolescents are more likely to be affected by mental disorders but less likely to use mental health services. This systematic review aimed to summarize factors related to mental health service use among minority adolescents in the U.S. as identified in previous research. Following the PRISMA guideline, we systematically searched seven databases for peer reviewed articles related to barriers and facilitators of mental health service use among racial/ethnic minority adolescents. Thirty-two quantitative studies met our inclusion criteria, among which 12 studies (37.5%) sampled mostly Blacks or African Americans, 6 studies (18.7%) focused primarily on Hispanics or Latin/a/x, including Mexican Americans and Puerto Ricans, and 4 studies (12.5%) were mostly Asian Americans (e.g., Chinese, Vietnamese). Based on the socio-ecological framework, 21 studies (65.6%) identified adolescent-related barriers and facilitators of mental health service use, including biological (e.g., age, gender), clinical (e.g., symptom severity), behavioral (e.g., drug/alcohol use), and psychological characteristics (e.g., internal asset) of minority youth. Ten studies (31.3%) identified parents-related factors that influenced minority adolescent mental health service use, including parental perceptions and beliefs, family and parenting issues, and demographic characteristics. Primary factors at the therapist level included ethnic match between patient and practitioner, relationship with healthcare practitioners, and patient-therapist co-endorsement of etiological beliefs. Fifteen studies (46.9%) identified factors influencing minority adolescent mental health service use at the contextual/structural level, including household income, insurance status, and family structure. Lastly, acculturation and school experiences were major factors at the social/cultural level that influence minority adolescent service use. More empirical studies are needed to understand the mechanism underlying minority adolescents' unmet mental health service needs. Culturally competent interventions are warranted to engage minority adolescents with mental disorders into treatment.
精神障碍在美国是严重的公共卫生问题。与白人相比，少数族裔青少年更容易受到精神障碍的影响，但使用精神卫生服务的可能性较小。本系统综述旨在总结先前研究中确定的与美国少数族裔青少年心理健康服务使用相关的因素。根据 PRISMA 指南，我们系统地在七个数据库中搜索了与少数族裔青少年精神卫生服务使用的障碍和促进因素相关的同行评审文章。32 项定量研究符合我们的纳入标准，其中 12 项研究（37.5%）主要抽样于黑人和非裔美国人，6 项研究（18.7%）主要集中于西班牙裔或拉丁裔/裔，包括墨西哥裔和波多黎各裔，4 项研究（12.5%）主要为亚裔美国人（如中国人、越南人）。根据社会生态学框架，21 项研究（65.6%）确定了青少年精神卫生服务使用的障碍和促进因素，包括青少年的生物学（如年龄、性别）、临床（如症状严重程度）、行为（如药物/酒精使用）和心理特征（如内在资产）。10 项研究（31.3%）确定了影响少数族裔青少年精神卫生服务使用的父母相关因素，包括父母的看法和信念、家庭和育儿问题以及人口统计学特征。治疗师层面的主要因素包括患者和从业者之间的种族匹配、与医疗保健从业者的关系以及患者与治疗师共同认可的病因信念。15 项研究（46.9%）确定了影响少数族裔青少年精神卫生服务使用的背景/结构层面的因素，包括家庭收入、保险状况和家庭结构。最后，文化适应和学校经历是影响少数族裔青少年服务使用的社会/文化层面的主要因素。需要更多的实证研究来了解少数族裔青少年未满足的心理健康服务需求的机制。需要实施文化能力干预措施，让患有精神障碍的少数族裔青少年参与治疗。
