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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As expected, a larger number of adults in the household appears to relax time or other resource constraints and facilitates children receiving treatment for depression. Previous research has provocatively found that one-parent families are more likely to use services (controlling for recent changes in family structure), but not less likely to have unmet need (Zwaanswijk et al. 2003). This study enhances these results in two ways. First, the results here suggest that since the number of adults matters, not just having a two-parent family, the effect may be about resource constraints. Grandmothers may be just as effective as husbands at making sure children get needed treatment. Or indeed more so. Controlling for the number of adults, the presence of the father in the results here inhibits children getting treatment in general and for depression in particular. One possible explanation for this result may be that fathers are more inimical to the idea of treatment for mental health and favor an approach of "toughing it out."

The race/ethnicity variables are more significant than are the socioeconomic status variables. African American children are much less likely to get treatment for depression controlling for need and for a host of socioeconomic and demographic variables that one might expect to confound this relationship. Accordingly, with odds ratios of 0.14-0.28 for the different depression measures, it appears that there are very meaningful barriers for African American children in obtaining depression care. By contrast, African American children are no less likely than white children to get treatment for behavior disorders, a result that probably also drives the result that overall, African Americans are no less likely to get treatment for any mental health problem. Latino children are significantly less likely to get treatment for behavior problems, for any condition overall, and for depression than white children. Here again the odds ratios of 0.33 for any visit, 0.28-0.30 for depression, and 0.15 for behavior problems are quite dramatic.

These results could reflect a referral effect, since it has been shown that African Americans adults who discuss depression with their primary care providers are less likely than whites to get a referral to a mental health specialist, controlling for severity (Borowsky et al. 2000). It could also be related to different mental health treatment preferences in the African American and Latino communities, whose members may prefer informal family- or community-based treatment to medicalized treatment (Scheffler and Miller 1989). Evidence has been reported, for example, that African Americans hold more negative views of treatment outcomes (Richardson 2001). Finally, race/ethnicity may interact with perceptions of need for treatment, particularly in parsing information from school teachers and counselors (Slade 2004). Clearly for both African Americans and for Latinos there are unmet needs that merit both action and further research to understand the reasons behind the lack of adequate care.