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Racial and ethnic disparities in unmet need for mental health care among children: A nationally representative study

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

There is a dearth of large, nationally representative studies that examine racial/ethnic disparities in self-reported unmet need for mental health care among children and youth.

Objective

This study assessed racial/ethnic disparities in unmet need for mental health care, use of psychotropic medication, and reasons for forgone care among children and youth.

Methods

This nationally representative cross-sectional study analyzed data from the combined 2016–2020 National Survey of Children’s Health (n = 151,876). Bivariate statistics and multivariable logistic regression models assessed the association between race/ethnicity, unmet need for mental health care, and use of psychotropic medication. Reasons for forgone care were also examined.

Results

Black non-Hispanic children and youth had approximately twice the odds of unmet mental health care needs (AOR, 1.97; 95% CI 1.53–2.55) as White non-Hispanic children and youth. The likelihood of reporting that it was not possible to see a mental health professional was higher for Black non-Hispanic (AOR, 3.39; 95% CI 1.64–7.01) and Multi-racial/Other non-Hispanic children and youth (AOR, 2.96; 95% CI 1.40–6.25) compared with White non-Hispanic peers. Black non-Hispanic, Hispanic, and Multi-racial/Other non-Hispanic children and youth were also less likely to use psychotropic medication (p < 0.001). Common reasons for forgoing care included cost, problems getting an appointment, and lack of transportation or childcare.

Conclusions

This study found significant racial/ethnic disparities in unmet mental health care, psychotropic medication use, and barriers in accessing mental health care. Data from this study suggest that eliminating these disparities requires policy interventions that address medical and societal barriers to health care access and quality.

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Data Availability

Data is publicly available and can be accessed from https://www.childhealthdata.org/learn-about-the-nsch/NSCH.

Code Availability

Not applicable.

References

  1. Bitsko RH, Claussen AH, Lichstein J, et al. Mental Health Surveillance Among Children - United States, 2013–2019. MMWR Suppl. 2022;71:1–42.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Perou R, Bitsko RH, Blumberg SJ, et al. Mental health surveillance among children–United States, 2005–2011. MMWR Suppl. 2013;62:1–35.

    PubMed  Google Scholar 

  3. Whitney DG, Peterson MD. US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatr. 2019;173:389–91.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Doupnik SK, Rodean J, Feinstein J, et al. Health Care Utilization and Spending for Children With Mental Health Conditions in Medicaid. Acad Pediatr. 2020;20:678–86.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Curtin SC, Heron M. Death Rates Due to Suicide and Homicide Among Persons Aged 10–24: United States, 2000–2017. NCHS Data Brief. 2019;352:1–8.

    Google Scholar 

  6. Bitsko RH, Holbrook JR, Ghandour RM, et al. Epidemiology and Impact of Health Care Provider-Diagnosed Anxiety and Depression Among US Children. J Dev Behav Pediatr. 2018;39:395–403.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Centers for Disease Control and Prevention. Youth Risk Behavior Survey: data summary & trends report 2011–2021. Atlanta, GA: US Department of Health and Human Services, CDC; 2023.

    Google Scholar 

  8. Lu W. Adolescent Depression: National Trends, Risk Factors, and Healthcare Disparities. Am J Health Behav. 2019;43:181–94.

    Article  PubMed  Google Scholar 

  9. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

  10. Benton TD, Boyd RC, Njoroge WFM. Addressing the Global Crisis of Child and Adolescent Mental Health. JAMA Pediatr. 2021;175:1108–10.

    Article  PubMed  Google Scholar 

  11. Alegría M, Green JG, McLaughlin KA, Loder S. Disparities in child and adolescent mental health and mental health services in the US. New York, NY: William T. Grant Foundation; 2015. p. 26.

    Google Scholar 

  12. Rodgers CRR, Flores MW, Bassey O, et al. Racial/Ethnic Disparity Trends in Children’s Mental Health Care Access and Expenditures From 2010–2017: Disparities Remain Despite Swee** Policy Reform. J Am Acad Child Adolesc Psychiatry. 2022;61:915–25.

    Article  PubMed  Google Scholar 

  13. Marrast L, Himmelstein DU, Woolhandler S. Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study. Int J Health Serv. 2016;46:810–24.

    Article  PubMed  Google Scholar 

  14. Costello EJ, He JP, Sampson NA, et al. Services for Adolescents With Psychiatric Disorders: 12-Month Data From the National Comorbidity Survey-Adolescent. Psychiatr Serv. 2014;65:359–66.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cummings JR, Ji X, Lally C, Druss BG. Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth. J Am Acad Child Adolesc Psychiatry. 2019;58:128–38.

    Article  PubMed  Google Scholar 

  16. Cook BL, Barry CL, Busch SH. Racial/Ethnic Disparity Trends in Children’s Mental Health Care Access and Expenditures from 2002 to 2007. Health Serv Res. 2013;48:129–49.

    Article  PubMed  Google Scholar 

  17. Zablotsky, B., & Terlizzi, E. P. (2020). Mental Health Treatment among Children Aged 5-17 Years: United States, 2019. NCHS Data Brief. No. 381. National Center for Health Statistics.

  18. Huang KY, Calzada E, Cheng S, Brotman LM. Physical and mental health disparities among young children of Asian immigrants. J Pediatr. 2012;160:331-336.e331.

    Article  PubMed  Google Scholar 

  19. Centers for Disease Control and Prevention. Unmet Need. Available at: https://www.cdc.gov/nchs/hus/sources-definitions/unmet-need.htm. Accessed March 2023.

  20. Carr W, Wolfe S. Unmet needs as sociomedical indicators. Int J Health Serv. 1976;6:417–30.

    Article  CAS  PubMed  Google Scholar 

  21. Andersen R. Health status indices and access to medical care. Am J Public Health. 1978;68:458–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Goldstein AB, Oudekerk BA, Blanco C. From Prevention Science to Services: Identifying Paths to Sustainable Evidence-Based Preventive Interventions. Psychiatr Serv. 2023;74:564–5.

    Article  PubMed  Google Scholar 

  23. United States Census Bureau. National Survey of Children’s Health (NSCH). Available at: https://www.census.gov/programs-surveys/nsch/data.html. Accessed March 2023.

  24. Data Resource Center for Child and Adolescent Health. NSCH Survey Methodology. Available at: https://www.childhealthdata.org/learn-about-the-nsch/methods. Accessed March 2023.

  25. Casseus M, Cheng J. Children with Cerebral Palsy and Unmet Need for Care Coordination. J Dev Behav Pediatr. 2021;42:605–12.

    Article  PubMed  Google Scholar 

  26. Shim R, Szilagyi M, Perrin JM. Epidemic Rates of Child and Adolescent Mental Health Disorders Require an Urgent Response. Pediatrics. 2022;149(5). https://doi.org/10.1542/peds.2022-056611

  27. Benevides TW, Carretta HJ, Mandell DS. Differences in Perceived Need for Medical, Therapeutic, and Family Support Services Among Children With ASD. Pediatrics. 2016;137:S176.

    Article  PubMed  Google Scholar 

  28. Cook BL, Hou SS-Y, Lee-Tauler SY, et al. A Review of Mental Health and Mental Health Care Disparities Research: 2011–2014. Med Care Res Rev. 2019;76:683–710.

    Article  PubMed  Google Scholar 

  29. Casseus M, Kim WJ, Horton DB. Prevalence and treatment of mental, behavioral, and developmental disorders in children with co-occurring autism spectrum disorder and attention-deficit/hyperactivity disorder: A population-based study. Autism Res. 2023;16:855–67.

    Article  PubMed  Google Scholar 

  30. Walkup J. Practice parameter on the use of psychotropic medication in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2009;48:961–73.

    Article  PubMed  Google Scholar 

  31. Walter HJ, Abright AR, Bukstein OG, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2023;62:479–502.

    Article  PubMed  Google Scholar 

  32. Walter HJ, Bukstein OG, Abright AR, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry. 2020;59:1107–24.

    Article  PubMed  Google Scholar 

  33. Lu W, Bessaha M, Muñoz-Laboy M. Examination of Young US Adults’ Reasons for Not Seeking Mental Health Care for Depression, 2011–2019. JAMA Netw Open. 2022;5:e2211393–e2211393.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mason MJ, Keyser-Marcus L, Snipes D, et al. Perceived Mental Health Treatment Need and Substance Use Correlates Among Young Adults. Psychiatr Serv. 2013;64:871–7.

    Article  PubMed  Google Scholar 

  35. Kalb LG, Stapp EK, Ballard ED, Holingue C, Keefer A, Riley A. Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US. Pediatrics. 2019;143(4). https://doi.org/10.1542/peds.2018-2192

  36. Alvarez K, Cervantes PE, Nelson KL, Seag DEM, Horwitz SM, Hoagwood KE. Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change. J Am Acad Child Adolesc Psychiatry. 2022;61(9):1087-1105. https://doi.org/10.1016/j.jaac.2021.12.006

  37. Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996–2016. JAMA. 2020;323:863–84.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Health Resources and Services Administration. Integrating behavioral health and primary care for children and youth. Available at: https://www.integration.samhsa.gov/integrated-care-models/Overview_CIHS_Integrated_Care_Systems_for_Children.pdf. Accessed Sept 2023.

  39. Tyler ET, Hulkower RL, Kaminski JW. Behavioral health integration in pediatric primary care. Milbank Memorial Fund. 2017;15:1–24.

    Google Scholar 

  40. Asarnow JR, Rozenman M, Wiblin J, Zeltzer L. Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis. JAMA Pediatr. 2015;169:929–37.

    Article  PubMed  Google Scholar 

  41. So M, McCord RF, Kaminski JW. Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review. Adm Policy Ment Health. 2019;46:334–51.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Centers for Disease Control and Prevention. Improving Access to Children’s Mental Health Care. Available at: https://www.cdc.gov/childrensmentalhealth/access.html. Accessed Sept 2023.

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Funding

This work was supported by the U.S. Department of Health and Human Services Health Resources and Services Administration (award numbers U3DMC32755-01-00 and T32HP42017‐02‐00). The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the US Government.

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Authors and Affiliations

  1. Division of Population Health, Quality, and Implementation Science, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA

    Myriam Casseus

  2. Child Health Institute of New Jersey, New Brunswick, NJ, USA

    Myriam Casseus

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Correspondence to Myriam Casseus.

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Casseus, M. Racial and ethnic disparities in unmet need for mental health care among children: A nationally representative study. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01801-4

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