Help-seeking preceding mental health clinic intake among African-American, Latino, and Caucasian youths

Parents' clinical depression and children's problem behaviors: A multi-level meta-analytic examination

BACKGROUND

Previous meta-analyses considering associations between parental depression (PD) and child symptoms have considered PD based primarily on self-report of depression symptoms. The present meta-analysis, in contrast, evaluated the effect of parents' clinically-diagnosed depressive disorders (PDD) on child internalizing and externalizing symptoms and considered both family- and study-level variables that influenced the strength of these effects.

METHODS

We examined 111 effect sizes nested in 40 studies including a clinical assessment of parents' major or persistent depressive disorder and measures of children's internalizing or externalizing behaviors published between 2000 and 2020. We used a multi-level meta-analytic framework to account for nesting of multiple effect sizes within studies.

RESULTS

PDD was associated with children's internalizing (weighted mean r = 0.211) and externalizing (weighted mean r = 0.204) behaviors. Family- and study-level variables moderated these relations, including the inclusion of fathers in the sample, the specific measure of internalizing behavior, reporting of diagnostic reliability, and informant for problem behaviors.

LIMITATIONS

Limitations include exclusive consideration of internalizing and externalizing symptoms (versus other symptom types or problems) and the limited number of father-only studies from which to base conclusions about the relative effect of maternal vs. paternal depression.

CONCLUSIONS

The similarity between the current findings and previous meta-analyses suggests that researchers studying the effects of PD may be able to bypass more exhaustive clinical interviews for less burdensome depression symptom inventories. Furthermore, our findings suggest that researchers and clinicians should consider how PD impacts not just child depressive symptoms, but myriad problem behaviors.

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

PURPOSE

This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization.

METHODS

Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence.

RESULTS

Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic.

DISCUSSION

Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

Treatment Engagement in Adolescents: The Associations of Sociodemographic Characteristics, Caregiver Perceived Barriers, and Clinical Impairment

OBJECTIVE

To examine the associations between sociodemographic characteristics, perceived barriers to treatment, clinical impairment, and youth treatment engagement.

METHOD

Participants included 196 families (youth: ages 12 to 18; 64.3% cis-gender female; 23.5% Black, 60.7% White, and 12.2% Mixed/Other race; 41.3% Hispanic or Latinx ethnicity) recruited as part of a comparative effectiveness trial for adolescent anxiety and depression. Self-report measures of sociodemographic characteristics and caregiver perceived barriers were completed at intake. Youth clinical impairment was assessed at baseline via clinical interview. Measures of engagement were collected throughout treatment, including initiation status, session attendance, and termination status. Relationships were examined using analyses of variances and hierarchal linear and logistic modeling.

RESULTS

Perceived barriers did not differ by sociodemographic characteristics. Greater perceived stressors and obstacles predicted fewer sessions attended and a lower likelihood of successful termination. Youth of caregivers with an advanced degree and those with caregivers who were employed part time attended more sessions and were more likely to initiate and terminate treatment successfully compared to youth with caregivers of a lower education level or student or unemployed status. At higher levels of youth clinical impairment, greater perceived treatment demands and issues predicted reduced likelihood of treatment initiation.

CONCLUSIONS

Perceived barriers, sociodemographic characteristics, and clinical impairment were all associated with levels of engagement in the treatment process. Baseline and continued assessment of perceived and experienced barriers to treatment may promote individualized strategies for families identified as at-risk for reduced engagement.

Racial and ethnic differences in major depressive episode, severe role impairment, and mental health service utilization in U.S. adolescents

BACKGROUND/OBJECTIVES

This study aimed to examine racial and ethnic variations in national trends, past-year prevalence, determinants of major depressive episode (MDE), MDE-related role impairment and mental health (MH) services utilization in U.S. adolescents.

METHODS

Data was extracted from the National Survey on Drug Use and Health (NSDUH) from 2010 to 2018. A total of 137,671 nationally representative adolescents aged 12-17 were included in the study. Weighted temporal trends in the past-year prevalence of MDE, and MDE with severe role impairment were estimated both overall and by race and ethnicity. Weighted multivariate logistic regressions were conducted to assess racial/ethnic differences in determinants of MDE, MDE-related severe role impairment, and MH services utilization after adjusting for sociodemographic characteristics, family structure, substance use, activity participation, and problem-solving group engagement.

RESULTS

The prevalence of MDE and MDE with severe role impairment among U.S. adolescents has steadily increased, while MDE-related health services utilization remained low from 2010 to 2018. Racial and ethnic minority adolescents were more likely to experience an MDE, but less likely to use MH services compared to their White counterparts. Participating in school, family, community, or faith-based activities was significantly associated with lower MDE incidence. Problem-solving group engagement was associated with MH services utilization (all p-values < 0.05).

CONCLUSION

High prevalence of depression and low MH service utilization among U.S. adolescents remains a public health issue. Moreover, racial/ethnic disparities persist in MH and service utilization outcomes. Future research must investigate the burden and predictors of mental illness, and the factors influencing MH services utilization in diverse adolescent populations.

Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review

OBJECTIVE

Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents' mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children.

METHOD

This systematic review summarized existing evidence of parents' barriers to seeking mental healthcare for their children at risk of ADHD.

RESULTS

This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels.

CONCLUSION

Raising parents' awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents' seeking behavior and reduces barriers toward seeking mental healthcare is needed.

Socioeconomic Status, Race and Parental Initial Response to Children's Mental Illness

To examine how socioeconomic status (SES) and race affect parents' initial response (IR) to their child's mental illness (MI) including 1. Parental confidant(s); 2. Lag time in professional help-seeking; and 3. Referral source. 70 parents of patients new to a Child Psychiatry clinic completed a survey to assess their IR to their child's MI. SES was determined using the United States Census Bureau median income by zip codes. Summary statistics are frequencies and percentages for categorical data, and medians and quartiles for continuous data. Twenty-five percent of parents reported low SES and 31% Non-Caucasian Children (NCC). Confidants of Caucasian and NCC were Pediatrician (77% vs 50%, p = 0.03), and family (73% vs 32%, p = 0.002). Comparing help-seeking Lag Times 66% reported a delay of 1 year or more (p = 0.040). Overall Pediatricians were the leading confidant. Lag times were one year or more with stronger trends in NCC.

Expectations and Preferences for Psychotherapy Among African American and White Young Adults

OBJECTIVES

This study examined beliefs, expectations, and preferences related to mental health problems and treatment in a sample of young adults who are in a developmental period when many types of psychopathology emerge. Prior studies on this topic have primarily included samples that are older and predominately White. It is not clear whether results from that research generalize to diverse samples of young adults.

METHODS

Participants were 370 undergraduate students (41.3% African American; 76.5% female) who completed questionnaires about expectations and preferences for psychotherapy and therapists.

RESULTS

Findings regarding racial differences include African Americans having less experience with mental health services and different goals for psychotherapy than did Whites. Additionally, African Americans, relative to Whites, demonstrated stronger preferences for couple, family, and group psychotherapy, a male therapist their same race, and a therapist who is assertive and structured in session.

CONCLUSIONS

The results of this study provide information about young adults' perceptions, expectations, and preferences related to mental health problems and psychotherapy. Findings suggest some barriers to treatment that might be addressed to improve treatment engagement and utilization of psychological services among young adults in general and among African American young adults specifically.

Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda

INTRODUCTION

How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear.

METHODS

The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village.

RESULTS

Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them.

CONCLUSION

The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people's help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.

Access to Health Care and Mental Health Among Latino Students in San Diego

Purpose: Depression during adolescence has important consequences, and Latino adolescents face different mental health challenges compared with peers from other ethnic groups. In this article we investigate whether access to a primary care physician affects the mental health of Latino high school students. Methods: Our data are drawn from a unique sample survey conducted in San Diego County in 2016. Classrooms were randomly selected from six area high schools, and students currently attending school were recruited to complete the survey in class. Self-reported depression screener (Patient Health Questionnaire-2) and loneliness were collected as outcome variables, and access to a primary care physician was the main independent variable. Results: Our multilevel logistic regression linking access to a physician and being at risk for major depression resulted in an odds ratio (OR) of 0.316 (95% confidence interval [CI]: 0.184-0.544), whereas the multilevel logistic regression relating access to a physician and feeling lonely resulted an OR of 0.371 (95% CI: 0.215-0.639). Conclusion: This study provides evidence from a novel setting to demonstrate the link between mental health and access to health services within a minority population. Because many of the Latino adolescents in our sample come from mixed status families, this finding is particularly important in the current policy climate of the United States, in which the future of access to health care for many immigrant families is highly uncertain.

Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens' Autonomy Daily (STAND), a parent-teen Motivational Interviewing + Behavior Therapy intervention for adolescents with ADHD. Adolescents with ADHD (N = 225), who were clients at four community mental health agencies, received treatment from 82 therapists. There was double randomization of adolescents and therapists to STAND or Usual Care (UC). Nearly all therapists randomized to STAND completed the training and regularly attended supervision, rating STAND as acceptable and lower burden than UC practices. In the STAND group, MI competence and implementation were lower than in university trials (benchmark range, 19.5% for reflection to question ratio to 83.1% for technical globals). MI integrity in the STAND group was significantly higher than UC across most MITI indices. Content fidelity was adequate in STAND's engagement and skills phases (76.4-85.0%), but not its planning phase (24.4%). Therapists commonly neglected weekly review of goals and home practice and deviated from manualized pace and sequencing of therapy tasks. Learning MI was more challenging for bilingual therapists and therapists with more years of experience. STAND was delivered with higher integrity in earlier sessions and office-based sessions. Discussion identifies future directions for exporting adolescent ADHD interventions to community settings. Patient outcome data for this trial is presented elsewhere. Trial Registration: NCT02694939 www.clinicaltrials.gov .

Factors Associated With Use of Mental Health and Substance Use Treatment Services by Justice-Involved Youths

OBJECTIVE

Nonincarcerated (community-supervised) youths who are first-time offenders have high rates of mental and substance use disorders. However, little is known about their use of psychiatric services (mental health and substance use) or factors associated with service use. This study examined the prevalence, determinants, and barriers to service use among community-supervised youths.

METHODS

Data were from a longitudinal study of mental health and substance use outcomes among adolescents ages 12-18 from a northeastern family court in which caregivers and youths completed assessments (N=423 dyads). The Behavior Assessment System for Children, Second Edition, assessed youths' psychiatric symptoms. The Child and Adolescent Services Assessment assessed service use and barriers. Family functioning and caregiver-adolescent communication were assessed with the McMaster Family Assessment Device and the Parent-Adolescent General Communication Scale, respectively. Multivariable regression analyses examined the cross-sectional relationship between youths' service use and determinants of use at baseline.

RESULTS

Of the 423 youths, 49% experienced psychiatric symptoms and 36% used psychiatric services in the past 4 months. The highest adjusted odds of service use were associated with youths' psychiatric symptoms and caregivers' history of a psychiatric diagnosis. The lowest odds were associated with caregivers' identifying as being from racial and ethnic minority groups. Caregiver-reported barriers to service use differed according to prior service use and by caregiver race-ethnicity.

CONCLUSIONS

Results suggest a need for interventions to increase access to and engagement in psychiatric services for community-supervised youths and the importance of caregiver factors in designing such interventions.

A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial

: media-1vid110.1542/5984243450001PEDS-VA_2018-2738Video Abstract OBJECTIVES: To improve the mental health (MH) referral process for children referred from primary care to community mental health clinics (CMHCs) by using a community-partnered approach.

METHODS

Our partners were a multisite federally qualified health center and 2 CMHCs in Los Angeles County. We randomly assigned 6 federally qualified health center clinics to the intervention or as a control and implemented a newly developed telehealth-enhanced referral process (video orientation to the CMHC and a live videoconference CMHC screening visit) for all MH referrals from the intervention clinics. Our primary outcome was CMHC access defined by completion of the initial access point for referral (CMHC screening visit). We used multivariate logistic and linear regression to examine intervention impact on our primary outcome. To accommodate the cluster design, we used mixed-effect regression models.

RESULTS

A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, >80% of eligible intervention and control participants (174 of 213) went on to an MH visit.

CONCLUSIONS

A novel telehealth-enhanced referral process developed by using a community-partnered approach improved initial access to CMHCs for children referred from primary care.

A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents With Depression and/or Anxiety and Their Parents: Protocol for a Pilot Randomized Controlled Trial

Background

Few adolescents who experience depression or anxiety connect to mental health treatment. Supporting Our Valued Adolescents (SOVA) is a stakeholder-informed technology intervention that consists of 2 blog-format websites—one for adolescents and another for parents. SOVA is designed to intervene on targets, which may increase the mental health treatment uptake when adolescents with depression or anxiety are identified in primary care settings.

Objective

This study aims to describe the protocol for a pilot randomized controlled trial designed to refine recruitment and retention strategies, document intervention fidelity and implementation outcomes, and assess changes in health beliefs and knowledge, emotional or informational support, and parent-adolescent communication quality in adolescents and their parents.

Methods

Adolescents identified with symptoms of depression or anxiety, for which a health care provider recommends treatment, and their parents will be recruited from clinics where adolescents are seen for primary care. Adolescent-parent dyads will be randomized at 1:1 to both receive the SOVA websites and enhanced usual care or enhanced usual care alone. Baseline measures and 6-week and 3-month outcomes will be collected by Web-based self-report surveys and electronic health record review. The main pilot outcome is the 6-week study retention rate. Analyses will also assess changes in health beliefs and knowledge, emotional support, and parent-adolescent communication in both adolescents and their parents.

Results

The project was funded in 2017. Recruitment commenced in April 2018 and enrollment is ongoing, with completion anticipated at the end of 2019 with subsequent plans for data analysis and publication submission in early 2020.

Conclusions

The findings of this research will inform the design of a multisite hybrid effectiveness-implementation randomized controlled trial examining the effectiveness and optimal implementation strategies for using SOVA in community primary care settings.

Trial Registration

ClinicalTrials.gov NCT03318666; https://clinicaltrials.gov/ct2/show/NCT03318666

International Registered Report Identifier (IRRID)

PRR1-10.2196/12117

Understanding stress in parents of children with autism spectrum disorder: A focus on under-represented families

OBJECTIVES

Parents of children with autism spectrum disorder (ASD) report high levels of stress that can interfere with important child and family treatments. Limited past research considers how the caregiving experience and social determinants of health may contribute to treatment engagement and outcomes, particularly in under-represented families, who already experience service and health disparities. We aimed to assess the experiences of caring for an individual with ASD, with specific emphasis on perceptions of stress.

METHODS

Three key informant interviews were conducted with parents (n=1) and providers (n=2) of children with ASD to refine interview guide questions. Once questions were refined, four focus groups (n=17) and one key informant interview were conducted with parents of children with ASD who were (a) non-white, (b) Spanish speakers, (c) of limited financial resources, and/or (d) living in rural counties. All participants lived in Western New York, with the majority residing in Rochester. Content analysis by two independent coders was used to identify and refine themes.

RESULTS

Themes included: (a) caregiving for an individual with ASD can cause interference with family functioning, (b) misperceptions of ASD contribute to caregiver stress, (c) culture contributes to stressors for parents, and (d) service navigation difficulties are a significant source of stress. Suggestions for interventions to address parents stress included: modular and integrative treatments for multiple content areas, addressing cultural barriers to treatment engagement, and education on ASD to the community.

CONCLUSIONS

Parent-focused interventions for caregivers of children with ASD should specifically explore and address service and health disparities for parents, especially those predicated on race, ethnicity, rurality, and language of origin. Interventions should also be individualized to parent characteristics and experiences. In future research on parent training, the unique contributions of caregiver stress and other characteristics (e.g., race-related stress, geographic location) should be included as potential modifiers of treatment.

Race influences parent report of concerns about symptoms of autism spectrum disorder

Racial differences in parent report of concerns about their child's development to healthcare providers may contribute to delayed autism spectrum disorder diagnoses in Black children. We tested the hypotheses that compared to White parents, Black parents of children with autism spectrum disorder would report fewer concerns about autism symptoms and would be more likely to report concerns about disruptive behaviors. A sample of 18- to 40-month-old toddlers ( N = 174) with autism spectrum disorder and their parent participated. After screening positive for autism spectrum disorder risk, but prior to a diagnostic evaluation, parents completed free-response questions soliciting concerns about their child's development. Parent responses were coded for the presence or the absence of 10 possible concerns, which were grouped into autism concerns (e.g. social and restricted and repetitive behavior concerns) or non-autism concerns (e.g. general developmental and disruptive behavior concerns). Compared to White parents, Black parents reported significantly fewer autism concerns and fewer social and restricted and repetitive behavior concerns. However, Black parents did not report significantly fewer non-autism concerns. Race did not influence parent report of disruptive behavior concerns. Lower reporting of autism concerns by Black parents may impact providers' abilities to identify children who need further screening or evaluation.

Factor Structure and Psychometric Properties of the Thoughts About Psychotherapy Survey in a Parent Sample

Researchers have noted that treatment fearfulness (e.g., embarrassment or negative attitudes) causes individuals to avoid seeking therapy. The purpose of this study was to examine the psychometric properties of the Thoughts About Psychotherapy Survey (TAPS; Kushner and Sher in Prof Psychol Res Prac 20(4):251-257, 1989) in a sample of parents. This study also examined differences in therapy fears among parents with and without a history of using mental health services. Using a sample of 138 parents (87% female), findings indicated that a three factor structure of the TAPS was a good fit for the data. Furthermore, the scales demonstrated "good" internal consistency ranging from .86 to .93. Finally, parents that reported previous use of mental health services reported fewer treatment fears. Given these findings, the TAPS appears to be a valid measure to assess treatment fears among parents. Implications for research and practice will be discussed.

Pathways to mental health services for young people: a systematic review

PURPOSE

While early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems.

METHODS

Studies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11-30 years. Two reviewers independently screened articles and extracted data.

RESULTS

Forty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths' pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways.

CONCLUSIONS

Except in psychosis, youths' pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.

Barriers to Mental Health Treatment Utilization in Wards 7 and 8 in Washington, DC: A Qualitative Pilot Study

Purpose: There is a paucity of data on barriers to mental health treatment utilization among residents of Wards 7 and 8 in Washington, DC, despite exposure to many environmental factors that are associated with poor mental health outcomes and the high prevalence of mental health problems among residents. The objective of this study was to examine barriers to mental healthcare utilization among residents of Wards 7 and 8.

Methods: This study included semi-structured, in-depth interviews with five key informants who lived or spent significant time in Wards 7 or 8 in Washington, DC, which are the wards served by Paving the Way MSI, a behavioral health clinic that served as a partner organization in the study.

Results: Barriers to mental health treatment utilization existed at a variety of social-ecological levels, including the individual/interpersonal level, the provider/mental health system level, the community level, and the societal level. Major barriers included fear and trust/distrust in the medical system, lack of social support, the model of mental healthcare, lack of patient-centered care, limited access to mental health services, stigma of mental illness and mental health treatment, and poverty.

Conclusion: This study highlights the need to address barriers to mental health treatment utilization at multiple social-ecological levels. Future studies should examine perspectives from residents with mental health problems in these wards to gain a more thorough understanding of the barriers to treatment. Funding is needed to support efforts to increase mental health treatment utilization among residents of Wards 7 and 8.

Black and White Parents' Willingness to Seek Help for Children's Internalizing and Externalizing Symptoms

OBJECTIVE

Understanding social and environmental factors that contribute to parental help-seeking intentions is an important step in addressing service underutilization for children in need of treatment. This study examined factors that contribute to parents' intentions to seek formal and informal help for child psychopathology (anxiety and attention-deficit/hyperactivity disorder [ADHD]).

METHOD

A total of 251 parents (N = 128 mothers, N = 123 fathers; 49% Black, 51% White) read 3 vignettes describing children with anxiety, ADHD, and no diagnosis. Measures of problem recognition, perceived barriers, and formal (pediatricians, psychologists, teachers) and informal (religious leaders, family/friends, self-help) help seeking were completed. Four separate hierarchical logistic regression models were used to examine parental help-seeking likelihood from formal and informal sources for internalizing and externalizing symptoms. Predictors were socioeconomic status, parent race, age, and sex, parent problem recognition (via study vignettes), and perceived barriers to mental health service utilization.

RESULT

Mothers were more likely than fathers to seek help from pediatricians, psychologists, teachers, and religious leaders for child anxiety and pediatricians, religious leaders, and self-help resources for child ADHD. Black parents were more likely to seek help from religious leaders and White parents were more likely to use self-help resources. Problem recognition was associated with greater intentions to seek help from almost all formal and informal sources (except from friends/family).

CONCLUSION

Understanding factors that contribute to parental help seeking for child psychopathology is critical for increasing service utilization and reducing the negative effects of mental health problems. This study highlights the importance of decreasing help-seeking barriers and increasing problem recognition to improve health equity.

Symptom Recognition and Diagnosis of Cerebral Palsy in Nepal

Cerebral palsy (CP) is the most common movement disorder of childhood. Parents recognized the symptoms of CP at mean age of 13 months. However there was a mean delay of going to a doctor by 23 months and the mean age of diagnosis was 5½ years. Less than half of the CP children were diagnosed by a pediatrician and were receiving treatment methods with weak evidence base of efficacy. Delay in recognition of symptoms and help seeking due to lack of awareness and access to proper medical care and prevalent false beliefs were the leading reason for late diagnosis of CP in Nepal and thus children loose valuable time for intervention in their early developmental stage.

Modeling ADHD Child and Family Relationships

Little information is available on how to help families manage common negative sequelae of attention deficit/hyperactivity disorder (ADHD). This article is a report of the extent to which a theoretical formulation of child behavior, maternal distress, and family conflict was explained by data obtained from a community sample of families with children and adolescents with ADHD. Structural equation modeling was used to test the theoretical model. The primary variables of interest were (a) child behavior problems, (b) maternal distress, and (c) family conflict. The results suggest that maternal distress may mediate the relationship between child behavior problems and family conflict, indicating the critical importance of mothers in ADHD families and the need to provide them with additional support.

Treatment of Eating Disorders in Women

This article reviews the most recent treatment literature for anorexia nervosa, bulimia nervosa, and binge eating disorder and serves as a guide for recommended readings and therapist resources. The primary focus is on empirically tested treatment modalities; for each of these approaches reviewed, the theoretical background, nature of the intervention, and existing empirical support are summarized. The article also presents less researched, albeit promising, approaches to eating disorder treatment, describing the rationale and available research. A focus on multicultural issues, including the paucity of eating disorder treatment research among participants of color, and suggestions for building research and enhancing treatment effectiveness with ethnic minority clients, is incorporated throughout. Recommendations concerning pressing research needs are made, and a summary of clinical recommendations for each disorder is formulated.

Latino parental help seeking for childhood ADHD

To better understand the help seeking process that occurs within Latino families when a child is exhibiting behaviors consistent with attention-deficit/hyperactivity disorder (ADHD), qualitative and quantitative data from 73 Latino parents were examined. Findings suggest that most Latino parents in the current sample recognized ADHD symptoms as concerning and in need of professional help and reported being motivated to seek help. Unfortunately, they also appeared to lack knowledge about the etiology of and effective treatment for ADHD, and many identified barriers to seeking help. Future research must involve community collaborations aimed at increasing awareness and knowledge of ADHD and decreasing barriers to seeking help in targeted Latino communities.

Racial/ethnic differences in parent-reported barriers to accessing children's health services

The goals of this study were to identify whether barriers that parents perceived to using health care differed by service type (medical vs. mental health care) and whether there were racial/ethnic differences in barriers. Participants were a community sample of 275 parents (34.2% African American, 36.7% Caucasian, and 29.1% Hispanic) of children ages 9-13 years old who rated the extent to which potential barriers in 3 broad domains (stigma-related, logistical, and socioeconomic) would prevent or delay them from obtaining services. They also rated internalizing and externalizing problems exhibited by their child. Overall, parents reported greater socioeconomic and stigma-related barriers to obtaining mental health services than medical services. Hispanic parents reported socioeconomic and stigma-related barriers as more inhibiting than did African-American parents. Findings highlight the importance of strengthening relationships between mental health care providers and the community to reduce the stigma associated with seeking mental health treatment for children and better educating parents about the potential benefits of treatment. Policy focused on educating parents about their insurance options and improving insurance coverage may help to reduce socioeconomic barriers.

Working together to solve disparities: Latina/o parents' contributions to the adaptation of a preventive intervention for childhood conduct problems

Left untreated, conduct problems can have significant and long-lasting negative effects on children's development. Despite the existence of many effective interventions, U.S. Latina/o children are less likely to access or receive evidence-based services. Seeking to build the foundation to address these service disparities, the current study used a Community-Based Participatory Research approach to examine U.S. Latina/o parents' perceptions of the need for interventions to prevent childhood disruptive behaviors in their community in general, and of an existing evidence-based intervention-parent-child interaction therapy (PCIT)-in particular. Results suggest that parents recognize a need for prevention resources in their community and value most of the core features of PCIT. Nevertheless, important directions for potential adaptation and expansion of PCIT into a prevention approach were identified. Results point to several goals for future study with the potential to ameliorate the unmet mental health needs experienced by U.S. Latina/o families with young children at risk for developing conduct problems.

Stigma experienced by people using mental health services in San Diego County

OBJECTIVE

This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems.

METHODS

This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness.

RESULTS

Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia.

CONCLUSIONS

Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.

Guidelines for establishing a telemental health program to provide evidence-based therapy for trauma-exposed children and families

Although similar rates of traumatic experiences exist in both rural and urban settings, mental health resources available to those living in rural areas are often scarce. Limited resources pose a problem for children and families living in rural areas, and several barriers to service access and utilization exist including reduced anonymity, few "after hours" services, decreased availability of evidence-based treatments, few specialty clinics, and expenses associated with travel, taking time off work, and provision of childcare. As a solution, the authors discuss the utility, use, and set-up of a telemental health program within an existing community outreach program. Suggestions for establishing a telemental health clinic are presented along with guidelines for the delivery of trauma-focused, cognitive-behavioral therapy (TF-CBT) via telemental health videoconferencing technology. Specific guidelines discussed include (1) establishing and using community partnerships, (2) Memoranda of Understanding (MOU), (3) equipment setup and technological resources, (4) videoconferencing software, (5) physical setup, (6) clinic administration, (7) service reimbursement and start-up costs, (8) therapy delivery modifications, and (9) delivering culturally competent services to rural and remote areas.

Racial/ethnic differences in perceived reasons for mental health treatment in US adolescents with major depression

OBJECTIVE

Racial/ethnic differences in the course of treatment for a major depressive episode (MDE) among adolescents may arise, in part, from variation in the perceived rationale for treatment. We examined racial/ethnic differences in the perceived reasons for receiving mental health (MH) treatment among adolescents with an MDE.

METHOD

A total of 2,789 adolescent participants who experienced an MDE and received MH treatment in the past year were drawn from the 2005 to 2008 National Survey on Drug Use and Health. Adolescents reported the settings in which they received care and reasons for their most recent visit to each setting. Distributions of specific depressive symptoms were compared across racial/ethnic groups. Racial/ethnic differences in endorsing each of 11 possible reasons for receiving treatment were examined using weighted probit regressions adjusted for sociodemographic characteristics, health and mental health status, treatment setting, and survey year.

RESULTS

Despite similar depressive symptom profiles, Hispanic adolescents were more likely than whites to endorse "breaking rules" or getting into physical fights as reasons for MH treatment. Black adolescents were more likely than white adolescents to endorse "problems at school" but less likely to endorse "felt very afraid or tense" or "eating problems" as reasons for treatment. Asian adolescents were more likely to endorse "problems with people other than friends or family" but less likely than whites to endorse "suicidal thoughts/attempt" and "felt depressed" as reasons for treatment.

CONCLUSION

Racial/ethnic minority participants were more likely than white participants to endorse externalizing or interpersonal problems and less likely to endorse internalizing problems as reasons for MH treatment. Understanding racial/ethnic differences in the patient's perceived treatment rationale can offer opportunities to enhance outcomes for depression among diverse populations.

Racial/ethnic disparities in ADHD diagnosis by kindergarten entry

BACKGROUND

Whether and to what extent racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis occur by kindergarten entry is currently unknown. We investigated risk factors associated with an ADHD diagnosis by kindergarten entry generally, and specifically whether racial/ethnic disparities in ADHD diagnosis occur by this very early time period.

METHODS

Secondary analysis of data from children enrolled in the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a large, nationally representative cohort of U.S. children born in 2001. Data include information from birth certificates, parent and teacher questionnaires, and in-person developmental assessments conducted with children at intervals from 9 months through kindergarten entry. The analytic sample included children enrolled in the ECLS-B at the 60-month assessment (N = 6,550).

RESULTS

Black children in the United States were 70% (1 - OR of .30) less likely to receive an ADHD diagnosis than otherwise similar White children. Hispanic children initially appeared to be underdiagnosed for ADHD. However, their disparity with Whites became statistically nonsignificant after controlling for whether a language other than English was primarily spoken in the home. Analyses of kindergarten teacher-reported classroom behavior indicated that neither Black nor Hispanic children displayed less frequent ADHD-related behaviors than Whites.

CONCLUSIONS

Although they are not less likely to display ADHD-related behaviors, children who are Black or being raised in households where non-English is primarily spoken are less likely than otherwise similar White children to be diagnosed with ADHD in the US.

The associations of race/ethnicity and suicidal ideation among college students: a latent class analysis examining precipitating events and disclosure patterns

The aim of this paper was to examine precipitating events for suicidal ideation and how these experiences relate to disclosure in a diverse sample of college students were examined. Among non-Hispanic White students, relationship/academic problems were most associated with ideation. A romantic break-up increased the odds of getting help. Among racial/ethnic minority students, family/academic problems were most associated with ideation and students who reported multiple events were less likely to get help compared with those not reporting events. Future research should examine the reasons for interpersonal conflict among this high-risk group and their attitudes about help-seeking, and identify cultural norms associated with disclosure.

Disparities in mental health care among HIV-infected youth

OBJECTIVE

Untreated psychiatric illness is detrimental to the health and well-being of HIV-infected youth. This study examines the relationships between social and demographic variables and the rates of psychiatric treatment among HIV-infected youth.

METHODS

Analyses are from a cross-sectional survey of 1706 HIV-infected youth (13-26 years) in care at treatment sites or affiliates of the Adolescent Medicine Trials Network for HIV/AIDS Interventions from 2010 to 2011. Among the youth who reported recent significant mental health symptoms, comparisons on demographic variables (including race, ethnicity, language spoken, level of education, sexual orientation, and household income) were made.

RESULTS

Psychiatrically symptomatic black youth were significantly less likely than symptomatic nonblack peers to receive mental health care (37.4% versus 48.6%) and psychiatric medications (19.3% versus 26.9%).

CONCLUSION

Care providers should be alerted to the potential disparities in mental health care treatment that exist for black youth living with HIV.

Guidelines for establishing a telemental health program to provide evidence-based therapy for trauma-exposed children and families

Although similar rates of traumatic experiences exist in both rural and urban settings, mental health resources available to those living in rural areas are often scarce. Limited resources pose a problem for children and families living in rural areas, and several barriers to service access and utilization exist including reduced anonymity, few "after hours" services, decreased availability of evidence-based treatments, few specialty clinics, and expenses associated with travel, taking time off work, and provision of childcare. As a solution, the authors discuss the utility, use, and set-up of a telemental health program within an existing community outreach program. Suggestions for establishing a telemental health clinic are presented along with guidelines for the delivery of trauma-focused, cognitive-behavioral therapy (TF-CBT) via telemental health videoconferencing technology. Specific guidelines discussed include (1) establishing and using community partnerships, (2) Memoranda of Understanding (MOU), (3) equipment setup and technological resources, (4) videoconferencing software, (5) physical setup, (6) clinic administration, (7) service reimbursement and start-up costs, (8) therapy delivery modifications, and (9) delivering culturally competent services to rural and remote areas.

Panic disorder in children and adolescents with noncardiac chest pain

Adults with panic disorder (PD) often present to medical settings with noncardiac chest pain (NCCP), but less is known about children and adolescents with this complaint. We sought to characterize PD in youth with NCCP and compare features with PD in youth in psychiatric outpatient settings. Using a semi-structured diagnostic interview we evaluated 132 youth (ages 8-17) with NCCP recruited from two medical settings. Twenty-seven (20.5 %) met full DSM-IV criteria for PD, eleven of which were children (<13 years). Most frequent panic symptoms were somatic complaints, although cognitive symptoms were also common. Only 14.8 % had clinically significant agoraphobia. Comorbid anxiety disorders and major depression were common. Overall, clinical features of PD among youth with NCCP are similar to PD in psychiatric settings. Interventions for PD may benefit youth who present initially with NCCP. Systematic psychiatric screening could increase detection of PD and improve care for this population.

Predictors of adequate depression treatment among Medicaid-enrolled youth

PURPOSE

To determine if Medicaid-enrolled youth with depressive symptoms receive adequate acute treatment, and to identify the characteristics of those receiving inadequate treatment.

METHODS

We used administrative claims data from a Medicaid-enrolled population in a large urban community to identify youth aged 6-24 years who started a new episode of treatment for a depressive disorder between August 2006 and February 2010. We examined rates and predictors of minimally adequate psychotherapy (four visits in first 12 weeks) and pharmacotherapy (filled antidepressant prescription for 84 of the first 144 days) among youth with a new treatment episode during the study period (n = 930).

RESULTS

Fifty-nine percent of depressed youth received minimally adequate psychotherapy, but 13 % received minimally adequate pharmacotherapy. Youth who began their treatment episode with an inpatient psychiatric stay for depression and racial minorities were significantly less likely to receive minimally adequate pharmacotherapy and significantly more likely to receive inadequate overall treatment.

CONCLUSIONS

While the majority of youth appear to be receiving minimally adequate acute care for depression, a substantial number are not. Given current child mental health workforce constraints, efforts to substantially improve the provision of adequate care to depressed youth are likely to require both quality improvement and system redesign efforts.

Assessing ADHD in Latino families: evidence for moving beyond symptomatology

OBJECTIVE

In an effort to combat the mental health disparities that exist among Latinos, the current study aimed to add to our knowledge related to culturally appropriate assessments for Latino children presenting with ADHD.

METHOD

As part of a larger study, a community sample of 68 Spanish-speaking, Latino parents completed the Spanish translation of the Disruptive Behavior Disorders Rating Scale (DBD-S), a commonly used, parent-report measure of ADHD.

RESULTS

Results suggest that although both the Inattentive and Hyperactive/Impulsive subscales of the DBD-S are psychometrically sound, the Hyperactive/Impulsive subscale may not be culturally appropriate with some Latino families, particularly those who are less acculturated. This was further supported by preliminary evidence suggesting that this subscale also was not diagnostically useful with the current, community sample.

CONCLUSION

The potential problems associated with the overemphasis on symptomatology when working with Latino families, the importance of examining functional impairment as part of a culturally appropriate assessment, and the need to replicate the current findings with a clinical sample are discussed.

Association between school engagement and disclosure of suicidal ideation to adults among Latino adolescents

We examined associations between Latino adolescents' school engagement and their likelihood of disclosing suicidal ideation (SI) to adults and of asking for help for SI. A first set of analyses was conducted on a total sample of 14 high schools, and a second set of analyses was conducted on 8 "Latino-representative" high schools. The criterion for Latino representation was that ≥10% of the school's total student population was Latino. Across all 14 high schools, 17% (110/663) of Latino students reported SI in the past year, compared to 13% (359/2,740) of non-Hispanic White students and 11% (78/719) of African American students. Of Latino students with SI, 24% (26/110) told an adult and 35% (38/110) sought help. In the 8 Latino-representative schools, higher levels of reported school engagement were associated with a greater likelihood of seeking help (OR = 6.17) and disclosure of SI to an adult (OR = 7.64) for Latino males. For Latinas, however, school engagement was not associated with either disclosure of SI to an adult or seeking help. Additional research is needed to clarify the processes, including social connectedness, that contribute to the disclosure of and help-seeking for SI among Latino adolescents.

Identifying and addressing mental health risks and problems in primary care pediatric settings: a model to promote developmental and cultural competence

Young children, particularly uninsured children of color, suffer from mental health disturbances at rates similar to older children and adults, yet they have higher rates of unmet needs. To address unmet needs, efforts to identify mental health problems in primary care pediatric settings have grown in recent years, thanks in large part to expanded screening efforts. Yet, health disparities in early detection remain. Enhancing understanding of how early childhood mental health problems can be identified and addressed within pediatric settings is an important and growing area of research. The authors draw on theoretical models from public health policy, health psychology, and child development, including health beliefs, help seeking, transtheoretical, motivation to change, and dynamic systems, to better understand and address challenges to and disparities in identifying and addressing mental health problems in pediatric settings. These theories have not previously been applied to early mental health screening and identification efforts. Developmental and sociocultural considerations are highlighted in an effort to address and reduce higher rates of unmet needs among young, uninsured children of color.

The parental attitudes toward psychological services inventory: adaptation and development of an attitude scale

The purpose of this paper is to provide psychometric data on the Parental Attitudes Toward Psychological Services Inventory (PATPSI), which is a revised measure to assess parents' attitudes toward outpatient mental health services. Using a sample of adults (N = 250), Study 1 supported a 3-factor structure (RMSEA = .05, NNFI = .94, and CFI = .94), adequate internal consistency (ranging from .72 to .92), and test-retest reliability (ranging from .66 to .84). Additionally, results indicated that individuals with previous use of mental health services reported more positive views toward child mental health services. Study 2 provided confirming evidence of the 3-factor structure (NNFI = .94, RMSEA = .08, and the CFI = .95) and adequate reliability (ranging from .70 to .90) using a parent-sample (N = 260). Additionally, discriminate validity of the PATPSI was supported. Implications for research and clinical practice are discussed.

Motivation for youth's treatment scale (MYTS): a new tool for measuring motivation among youths and their caregivers

Treatment motivation can be important for treatment adherence and outcomes, yet few measures of motivation are available for youths in mental health settings. These authors describe the psychometric properties of the motivation for youth's treatment scale (MYTS), an 8-item measure with forms for youths and caregivers that assesses their problem recognition and treatment readiness. Results indicate that the MYTS offers practitioners and researchers a brief, psychometrically sound tool for assessing treatment motivation of youths and their caregivers. Multivariate analyses of clinical and non-clinical characteristics of youths and caregivers show that youths' symptom severity consistently predicts treatment motivation for both groups. However, the strain of caring for the youth adds significantly to caregivers' recognition of the youth's troubles. While caregiver and youth motivations correlate, their agreement is low. Caregivers are nearly always more treatment motivated than youths. The authors discuss the implications of their findings for measurement, treatment planning, and future research.

The role of stigma in parental help-seeking for child behavior problems

The present study examined the relationship between stigma and parental help-seeking after controlling for demographics, child behavior, and barriers to treatment. One hundred fifteen parents of children ages 4 to 8 years were surveyed during well-child visits in a rural pediatric primary care practice. Parental perceptions of stigma toward parents and children were both assessed. Parents believe that children are more likely to be stigmatized by the public and personally impacted by stigma. In linear regression analyses, parents rated themselves as more likely to attend parenting classes with lower levels of self-stigma and greater levels of personal impact of stigma. Stigma toward the child was not associated with help-seeking. Child behavior moderated the relationship between stigma and parental help-seeking. When referring parents to treatment, providers should address potential stigma concerns. Future research should assess both the impact of the stigma of attending treatment and the stigma of having a child with behavior problems.

Role of referrals in mental health service disparities for racial and ethnic minority youth

OBJECTIVE

To investigate racial/ethnic differences in teachers' and other adults' identification and/or encouragement of parents to seek treatment for psychiatric problems in their children and to evaluate if and whether identification/encouragement is associated with service use.

METHOD

Data on identification/encouragement to seek treatment for externalizing disorders (i.e., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and/or conduct disorder) and internalizing disorders (i.e., major depressive episode/dysthymia and/or separation anxiety disorder) and services used were obtained for 6,112 adolescents (13-17 years of age) in the National Comorbidity Survey Adolescent Supplement. Racial/ethnic differences were examined for Latinos, non-Latino blacks, and non-Latino whites.

RESULTS

There were few racial/ethnic differences in rates of youth identification/encouragement and how identification/encouragement related to service use. Only non-Latino black youth with low severity internalizing disorders were less likely to be identified/encouraged to seek services compared with non-Latino white youth with the same characteristics (odds ratio [OR] = 0.4, 95% confidence interval [CI] = [0.2-0.7]). Identification/encouragement increased the likelihood of seeking services for externalizing and internalizing disorders for all youth. However, compared with their non-Latino white counterparts, non-Latino black youth who met criteria for internalizing disorders appeared less likely to have used any services (OR = 0.4, 95%, CI = 0.2-0.7), after adjusting for identification/encouragement, clinical, and sociodemographic characteristics. Non-Latino black youth with internalizing disorders and without identification/encouragement were less likely to use the specialty care sector than their non-Latino white counterparts.

CONCLUSIONS

In this study of a nationally representative sample of adolescents, almost no ethnic/racial differences in identification/encouragement were found. However, identification/encouragement may increase service use for all youth.

Self-Disclosure and Mental Health Service Use in Socially Anxious Adolescents

Social anxiety disorder is highly prevalent in adolescence, persistent into adulthood, and associated with multiple impairments. Despite the development of efficacious treatments for socially anxious youth, few affected adolescents receive such treatment. This study examined service use in a sample of high school students (n = 1,574), as well as predictors of treatment delay and factors associated with adolescents' disclosure of social difficulties. Self-report measures of social anxiety and service utilization were administered by study staff to 10th- and 11th-grade classrooms across three public high schools. Consistent with the literature, results indicated low treatment utilization (14 %) and lengthy delays in treatment initiation. Symptom severity, impairment, and disclosing anxiety to school personnel were significant predictors of service utilization. Several demographic and illness-specific factors were associated with a higher likelihood of disclosing social discomfort. These findings underscore the important role of school personnel in identifying and referring youth with anxiety disorders. Implications are discussed for increasing access to services, including school-wide screenings and training of school personnel to recognize and provide intervention for anxious youth.

Seeking professional help for mental health problems, among New Zealand secondary school students

OBJECTIVE

Our aim was to investigate whether secondary school students with mental health problems sought help from general practitioners and to investigate whether mental illness type, socio-demographic variables, family, school and community factors were associated with seeking help.

METHOD

A randomly selected sample of 9699 secondary school students from across New Zealand participated in the Youth2000 Health and Wellbeing Survey. Data analysis included uni-variate and regression analyses.

RESULTS

Having symptoms of anxiety (p<0.0001), depression (p<0.0001), and suicidal thoughts (p<0.0001) were associated with help seeking. However, 82%of students who had significant mental health problems had not sought help from a general practitioner. Rates of help seeking increased with age for girls and decreased with age for boys. Seeking help for mental health problems was also associated with living in a single parent family (p<0.0001), living in an over-crowded house (p=0.0006), and being well known by a teacher (p=0.0004).

CONCLUSIONS

The majority of New Zealand secondary school students with mental health problems do not obtain the help they need from general practitioners. Given the prevalence of mental health problems, it is important to find ways of identifying adolescents with difficulties and encouraging them to seek help.