Determinants of ambulatory mental health services use for school-age children and adolescents

Objective. To analyze a comprehensive multivariate model of the use of mental health-related ambulatory care services by children ages 6-17. Study Setting. The 1987 National Medical Expenditure Survey, a national probability sample of the U.S. civilian noninstitutionalized population. Study Design. A cross-sectional survey of a national probability sample of the U.S. population. Key independent variables include person-level mental health status, health care coverage, family income, and use of mental health services by other family members. Data Collection. Four in-person interviews were conducted during 1987 using structured questionnaires. A designated family respondent was used to answer questions for other family members, including children. Principal Findings. Children with poor mental health in high-income families were more than three times as likely to have a mental health-related visit than children with poor mental health in low-income families. The number of mental health-related visits and the likelihood of seeing a mental health specialist also increased along with family income. Mental health use by other family members was strongly associated with use. Conclusions. The results from this study provide strong evidence that the socioeconomic status of children is an important factor in explaining unmet need for mental health services.