Department of Medicine, University of California at Irvine, Irvine, USA.
Department of Psychology, College of Arts, Sciences, & Education, Florida International University, Miami, USA.
Adm Policy Ment Health. 2023 Jul;50(4):576-590. doi: 10.1007/s10488-023-01259-w. Epub 2023 Mar 17.
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, persistent, and costly mental health condition. The internet is an increasingly popular source for information related to ADHD. With a nationally representative sample (2018 NSCH), we aimed to separate individual- and state-level effects to examine inequities in ADHD diagnoses. We extracted state-level relative search volumes using "ADHD," "ADHD treatment," "ADHD medication," and "ADHD therapy" from Google Trends, and sociodemographic and clinical variables from the 2018 National Survey of Children's Health (N = 26,835). We examined state variation in ADHD-related information-seeking and applied multilevel modeling to examine associations among individual-level race/ethnicity, state-level information-seeking patterns, and ADHD diagnoses. Online information seeking related to ADHD varies by state and search term. Individual-level racial/ethnic background and state-level information-seeking patterns were associated with ADHD diagnoses; however, their cross-level interaction was not significant. This study adds to the strong body of evidence documenting geographical variation and diagnostic disparity in mental health and the growing literature on the impact of the digital divide on population health, indicating an urgent need for addressing inequities in mental health care. Increasing public interest in and access to empirically supported online information may increase access to care, especially among people of color.
注意缺陷多动障碍（ADHD）是一种普遍存在、持续存在且代价高昂的心理健康状况。互联网是与 ADHD 相关信息的越来越受欢迎的来源。我们采用具有全国代表性的样本（2018 年全国儿童健康调查，NSCH），旨在分离个体和州级层面的影响，以检查 ADHD 诊断中的不平等现象。我们从 Google Trends 中提取了州级相对搜索量，使用了“ADHD”、“ADHD 治疗”、“ADHD 药物”和“ADHD 疗法”，并从 2018 年全国儿童健康调查（N=26835）中提取了社会人口统计学和临床变量。我们检查了 ADHD 相关信息搜索的州差异，并应用多层模型来检验个体层面的种族/族裔、州级信息搜索模式和 ADHD 诊断之间的关联。与 ADHD 相关的在线信息搜索因州和搜索词而异。个体层面的种族/族裔背景和州级信息搜索模式与 ADHD 诊断相关；然而，它们的交叉水平交互作用并不显著。这项研究增加了大量关于心理健康的地理差异和诊断差异以及数字鸿沟对人口健康影响的文献，表明迫切需要解决心理健康护理中的不平等问题。公众对循证在线信息的兴趣和获取的增加可能会增加获得护理的机会，尤其是在有色人种中。
