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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It has been suggested in the literature that the failure to find an effect for SES or insurance on treatment probability might be because of having a large number of nonneedful people in the sample (Cunningham and Freiman 1996). For the reason the regression was also run on a subsample of children with high values of the symptom variables. The results (not reported) are quite similar to those for the full sample, although because of much smaller sample sizes, some results become insignificant. The symptomology variables are still significant, and of a similar magnitude. The SES and insurance variables continue to be insignificant, with very high p-values.

DISCUSSION

Much of the literature has found an association between needs and services use (Cunningham and Freiman 1996). However, the analysis here differs from most previous results in three important dimensions. First, this analysis covers only visits to specialty mental health providers, including psychiatrists, psychologists, and mental health counselors. To the extent that children's mental health concerns are addressed by primary care providers, such treatment is missed here. Second, most previous research has not broken down mental health needs and treatment by indication. Third, most previous research has focused on need as a dichotomous concept, whereas these regressions test whether increasing need leads to increasing likelihood of treatment.

Many of the family structure variables are highly significant and provide important insights into the social determinants of children's mental health services use. Girls are less likely to receive treatment overall, and much less likely to receive treatment for behavior problems in particular. Controlling for symptom level, girls are less than one-fifth as likely as boys to get needed treatment for behavior problems such as ADHD. Since these results control for symptom severity, it would appear that parents are neglecting the behavioral problems of their daughters more than those of their sons. This result confirms some of the previous research in this area (Bussing et al. 1998, 2003), which as mentioned above is contradictory. A possible reason for gender differences is that parents may think of behavioral problems as particular to boys and therefore are not sensitized to the need for treatment for some girls. Unfortunately, this gender disparity is not reversed in depression care, where girls are about half as likely as boys to get needed treatment.

Children in the middle of the birth order are less likely than oldest children to receive treatment overall and for both depression and behavior problems in particular. This result is noteworthy and important in that it is on the one hand consistent with a literature in economics that shows differences by birth order in the investment in children's health and nutrition, while on the other hand it extends this literature quite meaningfully by finding such a result for the United States: previously the literature has focused on developing countries. By contrast, unlike this literature, we do not find an effect for the total number of children. This result would appear to place U.S. families closer to Dutch families, in which family size was found to not be significant in one study (Zwaanswijk et al. 2003) as opposed to Finnish families, in which an effect of family size was found (Sourander et al. 2001).