Elsevier

Academic Pediatrics

Volume 9, Issue 2, March–April 2009, Pages 89-96
Academic Pediatrics

Disparities: Mental Health Care Use, Risk of Developmental Disorders
Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children

https://doi.org/10.1016/j.acap.2008.11.007Get rights and content

Objective

The aim of this study was to examine racial/ethnic differences in fifth grade children's mental health care utilization.

Methods

We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization.

Results

Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P < .001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models.

Conclusions

Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children.

Section snippets

Methods

Healthy Passages, funded by the Centers for Disease Control and Prevention, is a longitudinal study of a cohort of 5147 fifth graders and their parents that explores health behaviors, outcomes, and related risk and protective factors by using a multilevel approach. Baseline data collected from 2004 to 2006 were used for this analysis. Institutional review boards at each study site and the Centers for Disease Control and Prevention approved this study. “Healthy Passages” provides a comprehensive

Characteristics of All Children Using Mental Health Care

Nine percent of fifth graders had received care at some time in their lives for emotional, behavioral, or drug/alcohol problems (Table 1). Of these, 71% received care from mental health specialists (psychiatrist, psychologist, psychiatric nurse, clinical social worker, other mental health professional/specialist), 20% used school services only (school counselor, school psychologist, or other school mental health worker), and 9% received care from a primary care provider only (pediatrician,

Discussion

Our findings suggest that there is a significant and robust disparity in mental health care utilization for black children, which cannot be fully explained by racial/ethnic differences in child mental health, family sociodemographics, or parental social factors. This disparity persists even when just considering those children with symptoms of a mental health condition. It also exists in similar magnitude across all 4 examined mental health conditions. We did not find a disparity in utilization

Acknowledgments

The “Healthy Passages” study was funded by the Centers for Disease Control and Prevention, Prevention Research Centers (Cooperative Agreements U48DP000046, U48DP000057, and U48DP000056; Dr Mark A. Schuster). The authors thank Dr Greta Massetti for her review of this manuscript.

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