Role of neighbourhood social characteristics in children's use of mental health services between ages 9 and 13 years: a population-based cohort study in the Netherlands

Objectives This study aims to investigate the association of neighbourhood socioeconomic status (SES) and social cohesion (SC) within the neighbourhood with mental health service use in children, independent of individual-level characteristics and mental health problems. Design, setting and participants A longitudinal analysis was done using data from the Generation R Study, a prospective, population-based cohort of children born in Rotterdam, the Netherlands. These data were linked to the Neighbourhood Profile, containing registry and survey data on residents of Rotterdam. Data of 3403 children (mean age: 13.6 years, SD: 0.4) were used to study the associations between neighbourhood SES, SC (SC belonging and SC relations) and mental health service use, adjusted for mental health problems and sociodemographic characteristics. Outcome measures Mental health service use was reported by the accompanying parent at the research centre using the question: 'Did your child visit a psychologist or psychiatrist between 9 and 13 years old?'. Results Mental health services were used by 524 (15.4%) children between ages 9 and 13 years. No significant differences in mental health service use between neighbourhoods were identified (median OR: 1.07 (p=0.50)). The neighbourhood social characteristics were associated with mental health service use, but only when adjusted for each other. Children living in neighbourhoods with a low SES (OR 0.57 (95% CI 0.32 to 1.00)) or high SC belonging (OR 0.79 (95% CI 0.64 to 0.96)) were less likely to use services compared with children in a high SES or low SC belonging neighbourhood. SC relations was not associated with mental health service use. Conclusions Our findings indicate that children living in high SES neighbourhoods or in neighbourhoods where people feel less sense of belonging are more likely to use mental health services. As these associations were only present when studied jointly, more research is warranted on the complex associations of neighbourhood factors with children's mental health service use.