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Correlates of unmet need for mental health services by children and adolescents

Published online by Cambridge University Press:  01 September 1997

A. J. FLISHER ,
R. A. KRAMER ,
R. C. GROSSER ,
M. ALEGRIA ,
H. R. BIRD ,
K. H. BOURDON ,
S. H. GOODMAN ,
S. GREENWALD ,
S. M. HORWITZ  and
R. E. MOORE
...Show all authors
A. J. FLISHER
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
R. A. KRAMER
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
R. C. GROSSER
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
M. ALEGRIA
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
H. R. BIRD
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
K. H. BOURDON
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
S. H. GOODMAN
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
S. GREENWALD
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
S. M. HORWITZ
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
R. E. MOORE
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
W. E. NARROW
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
C. W. HOVEN
Affiliation:
From the Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York and State of New York Office of Mental Health, Albany, NY, Division of Epidemiology and Mental Health, National Institute of Mental Health, Rockville, MD, Department of Psychology, Emory University, Atlanta, GA and Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Cape Town, Republic of South Africa; and School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
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Abstract

Background. Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents.

Methods. Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months.

Results. Of the total sample, 17·1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parent's will. No youth-reported access barriers were significantly associated with unmet need.

Conclusions. The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.

Type
Research Article
Information
Psychological Medicine , Volume 27 , Issue 5 , September 1997 , pp. 1145 - 1154
Copyright
1997 Cambridge University Press

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