Graaf Genevieve, Hughes Phillip M, Gigli Kristin H, deJong Neal A, McGrath Robert E, Thomas Kathleen C
School of Social Work (G Graaf), University of Texas at Arlington.
Division of Pharmaceutical Outcomes and Policy (PM Hughes and KC Thomas), Eshelman School of Pharmacy, Chapel Hill, NC; Division of Research (PM Hughes), UNC Health Sciences at MAHEC, Asheville, NC; Cecil G. Sheps Center for Health Services Research (PM Hughes and KC Thomas), University of North Carolina, Chapel Hill, NC.
Acad Pediatr. 2025 Mar;25(2):102585. doi: 10.1016/j.acap.2024.09.009. Epub 2024 Oct 1.
This study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial and ethnic group, household income, and insurance type.
Using a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children's Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation.
Adjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states' probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups.
Geographic inequities in children's mental health care access persist; in some cases, they are larger than sociodemographic inequities.
本研究估算并比较了美国各州儿童心理健康护理需求未得到满足的概率以及获得护理的困难程度的差异。同时还针对全国三个社会经济和人口亚组（种族和族裔群体、家庭收入以及保险类型）进行了估算和比较。
本研究采用回顾性横断面设计，汇总了2016 - 2019年全国儿童健康调查数据。通过带有边际估计后分析的逻辑回归模型得出了全国、各州以及亚组层面经调整的照顾者报告的儿童心理健康护理需求未得到满足的概率以及获得心理健康护理的难易程度。
经调整后的全国照顾者报告的儿童心理健康需求未得到满足以及获得护理困难的概率分别为0.21和0.46。各州需求未得到满足的概率在0.08至0.32之间。有一个州显著高于全国估计值；九个州低于该值。各州获得心理健康护理困难的概率在0.28至0.57之间；九个州的概率显著低于全国估计值，两个州显著高于该值。心理健康需求未得到满足以及获得护理困难的估计值在各州之间的差异比在种族或族裔群体、收入群体、保险群体之间的差异更大。
儿童心理健康护理可及性方面的地理不平等现象依然存在；在某些情况下，这种不平等比社会人口统计学上的不平等更为严重。
