Smith Jessica V, Nevill Rose, DeGuzman Pamela B, Menezes Michelle, Mazurek Micah O
Department of Human Services School of Education and Human Development, University of Virginia, VA, USA.
School of Nursing, University of Virginia, VA, USA.
Adm Policy Ment Health. 2025 Jun 3. doi: 10.1007/s10488-025-01448-9.
Autistic youth have a high co-occurrence of mental health challenges and a resultant high need for mental health treatment. However, they experience mental health service disparities compared to non-autistic youth. Social determinants of health (SDH) may contribute to mental health service disparities among autistic youth, yet this has not been previously examined. Therefore, the present study utilized a validated composite of children's SDH to examine whether autistic youth with better SDH were more likely to use psychotherapy services compared to those with poor SDH using state-level records of insurance billing claims data (2019 All-Payer Claims Database). 700 autistic youth with a co-occurring mental health condition were included in analyses. One or more claim records for psychotherapy CPT codes were used as indicators of psychotherapy service use. SDH was assessed using the Childhood Opportunity Index, a continuous composite measure of neighborhood SDH. The predictive effect of SDH on psychotherapy use were examined, while examining covariates of insurance type and age. Approximately 70% of the sample did not use any psychotherapy services. Inconsistent with findings from non-autistic samples, autistic youth's SDH did not predict their likelihood of using psychotherapy services; rather, those with low and high opportunity alike did not access psychotherapy. Age increased the likelihood, and using Medicaid decreased the likelihood of psychotherapy service use. These results may highlight the compounded barriers to psychotherapy that autistic youth may experience, including the paucity of mental health providers who accept Medicaid and accept autistic youth clients.
患有自闭症的青少年心理健康问题并发率很高，因此对心理健康治疗的需求也很高。然而，与非自闭症青少年相比，他们在心理健康服务方面存在差异。健康的社会决定因素（SDH）可能导致自闭症青少年在心理健康服务方面存在差异，但此前尚未对此进行过研究。因此，本研究使用经过验证的儿童SDH综合指标，利用州级保险计费索赔数据记录（2019年全支付方索赔数据库），来检验与SDH较差的自闭症青少年相比，SDH较好的自闭症青少年是否更有可能使用心理治疗服务。分析纳入了700名同时患有心理健康问题的自闭症青少年。心理治疗CPT代码的一项或多项索赔记录被用作心理治疗服务使用情况的指标。使用儿童机会指数评估SDH，这是一种衡量邻里SDH的连续综合指标。在考察保险类型和年龄等协变量的同时，检验了SDH对心理治疗使用情况的预测作用。大约70%的样本未使用任何心理治疗服务。与非自闭症样本的研究结果不一致，自闭症青少年的SDH并不能预测他们使用心理治疗服务的可能性；相反，机会水平低和高的青少年都没有接受心理治疗。年龄增加了使用心理治疗服务的可能性，而使用医疗补助则降低了使用心理治疗服务的可能性。这些结果可能凸显了自闭症青少年在接受心理治疗方面可能面临的多重障碍，包括接受医疗补助且接纳自闭症青少年患者的心理健康服务提供者数量不足。
