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Demographic factors in the use of children's mental health services.

P Cohen and C S Hesselbart

New York State Psychiatric Institute, NY 10032.

OBJECTIVES. This study was designed to (1) determine mental health service use by children of varying age, sex, socioeconomic status, and urbanicity of residence; (2) compare the prevalence of mental disorder in children in these groups; and (3) determine the extent to which differences in service use are consonant with the prevalence differences. METHODS. Data on psychiatric diagnoses and service use were taken from a random longitudinal sample of 760 children. Information was gathered by interviews of mothers and of youth aged 12 to 21. RESULTS. Significant lags in mental health service use were found for youth 18 to 21 years of age, for those living in rural and semirural areas, and for those in middle-income families. To some extent, these service use differences paralleled differences in diagnostic rates. However, when diagnostic differences were controlled, the same patterns of service use inequalities were present. CONCLUSIONS. Mental health service use rates for youth vary by age, urbanicity, and family income. The underservice of middle-income and rural children may reasonably be ascribed to access problems; we explore explanations for the underservice of older youth.

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