Academic Pediatrics
Volume 9, Issue 2 , Pages 89-96, March 2009

Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children

Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, Calif (Dr Coker); RAND Corporation, Santa Monica, Calif (Drs Coker, Elliott, and Schuster); Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Calif (Dr Kataoka); Department of Psychology, University of Alabama at Birmingham, Birmingham, Ala (Dr Schwebel and Dr Mrug); Prevention Research Center Program, Centers for Disease Control and Prevention Research, Atlanta, Ga (Dr Grunbaum); Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston, Houston, Tex (Dr Cuccaro and Dr Peskin); and Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Mass (Dr Schuster)

Objective

The aim of this study was to examine racial/ethnic differences in fifth grade children's mental health care utilization.

Methods

We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization.

Results

Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P < .001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models.

Conclusions

Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children.

Key Words: mental health, racial/ethnic disparities, utilization

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 The findings and conclusions in this report are those of the authors and do not represent the official position of the Centers for Disease Control and Prevention.

PII: S1876-2859(08)00267-2

doi:10.1016/j.acap.2008.11.007

Academic Pediatrics
Volume 9, Issue 2 , Pages 89-96, March 2009

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