Graaf Genevieve, Snowden Lonnie
School of Social Work, University of Texas at Arlington, Arlington.
Department of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley.
Psychiatr Serv. 2025 Sep 1;76(9):809-817. doi: 10.1176/appi.ps.20240279. Epub 2025 Aug 14.
Mental health treatment disparities have been documented among children and youths. This study aimed to examine variations in disparities across U.S. states among Black children and Hispanic children (vs. White children). Disparities in caregiver-reported unmet mental health needs and difficulty in accessing mental health care were assessed.
This retrospective cross-sectional study used pooled data (2016-2019) from the National Survey of Children's Health. Logistic regression, with marginal postestimation and complex survey weights to reflect state and national probabilities, was used to estimate the direction, size, and statistical significance of disparities among Black (vs. White) children (N=5,900) and Hispanic (vs. White) children (N=10,369).
Adjusted state estimates showed significant (p<0.05) disparities in four U.S. states among Black (vs. White) children in the probability of having unmet mental health needs. Disparities in care access favoring Black children were found in four states. In one state, Black children were significantly more likely than White children to have caregiver-reported difficulty in accessing treatment. Hispanic (vs. White) children were significantly less likely to have caregiver-reported unmet mental health needs in seven states, but the opposite was found in one state. The probability of caregiver-reported difficulty in accessing care was significantly lower among Hispanic (vs. White) children in two states but was higher in three states.
Significant state variation in disparities was obscured by national averages. More policy and systems analysis is needed, especially at the state level, to uncover structural drivers of disparities in children's mental health care.
儿童和青少年心理健康治疗方面的差异已有记录。本研究旨在调查美国各州黑人儿童和西班牙裔儿童（与白人儿童相比）之间差异的变化情况。评估了照顾者报告的未满足的心理健康需求以及获得心理健康护理的困难程度方面的差异。
这项回顾性横断面研究使用了来自全国儿童健康调查（2016 - 2019年）的汇总数据。采用逻辑回归，并结合边际估计后分析和复杂的调查权重以反映州和全国的概率，来估计黑人（与白人相比）儿童（N = 5900）和西班牙裔（与白人相比）儿童（N = 10369）之间差异的方向、大小和统计学意义。
调整后的州估计显示，在美国四个州，黑人（与白人相比）儿童在有未满足的心理健康需求的概率方面存在显著（p < 0.05）差异。在四个州发现了有利于黑人儿童的护理获取差异。在一个州，黑人儿童比白人儿童更有可能出现照顾者报告的难以获得治疗的情况。在七个州，西班牙裔（与白人相比）儿童出现照顾者报告的未满足的心理健康需求的可能性显著较低，但在一个州情况相反。在两个州，西班牙裔（与白人相比）儿童出现照顾者报告的难以获得护理的概率显著较低，但在三个州则较高。
全国平均水平掩盖了各州之间差异的显著变化。需要进行更多的政策和系统分析，特别是在州一级，以揭示儿童心理健康护理差异的结构驱动因素。
