Social and economic determinants of disparities in professional help-seeking for child mental health problems: evidence from a national sample

Health Services Research,  Oct, 2005  by Frederick J. Zimmerman

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Because parents may proactively seek specialty mental health treatment for their children in the event of major family disruption, a dummy variable was included indicating whether the child's parents had been divorced, separated, or (for a very small number) widowed since the previous interview.

Two variables were used to represent the mother's mental health history and past treatment: her average score on the Center for Epidemiologic Studies Depression (CESD) instrument over the previous three survey waves represents her recent experience of depression; and her report of whether she had ever been formally diagnosed with depression represents her experience with mental health treatment. No information was available on other mental health issues, and no mental health information of any sort was available for the father. These are not perfect measures. For example, mother's CESD score may be only loosely correlated with depression. But they are reasonably proxies for the underlying constructs and far better than not controlling for these important constructs at all.

SOCIOECONOMIC DETERMINANTS OF CHILDREN'S SPECIALTY MENTAL HEALTH TREATMENT

Table 2 presents coefficient estimates from the logit regression equation (1). In each of the regressions, child's symptomology is strongly and meaningfully associated with the probability of receiving treatment. Controlling for household size, the presence of the father has a large, negative impact on the probability of receiving services, especially for depression. Girls are less likely to receive treatment overall, and the effect is strongest in the treatment for behavior problems. Middle children are less likely than oldest children to receive treatment for any reason, and for depression and behavior problems separately analyzed. Divorce in the recent past 2 years raises the probability of help-seeking, particularly for depression, and recent maternal experience with depression increases the probability of specialty help-seeking for depression; there is no effect of the mother's report of having been formally diagnosed for depression, a measure of her experience with depression treatment.

Children of employed mothers are more likely to get treatment overall and for depression in particular. None of the other socioeconomic status variables is significantly associated with treatment, and almost none of the insurance variables are--the sole exceptions being that having government insurance is associated with a greater probability of receiving treatment for behavior problems and private parental insurance with a reduced probability of treatment. Race/ethnicity is significant in several of the regressions: African Americans are less likely than whites, other things equal, to have treatment for depression, and the effect is quite large, whether symptomology is controlled through maternal report or through child report. Latinos are less likely than whites to obtain treatment for depression or behavior problems. This effect size too is large. These results corroborate a general sense in the literature, encapsulated for adults in the recent Surgeon General's report on minority mental health (U.S. Department of Health and Human Services 2001), that minority status places people at risk for inadequate treatment. Children who attend private school are more likely to get treatment for depression than are children who attend public school. Rural residents are no less likely to obtain treatment than nonrural residents, controlling for other factors.