Journal of Child and Family Studies

, Volume 21, Issue 4, pp 603–611 | Cite as

Predictors of Service Utilization Among Youth Diagnosed with Mood Disorders

  • Amy N. MendenhallEmail author
Original Paper


In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the Multi-Family Psychoeducational Psychotherapy study (MF-PEP), a randomized controlled trial of 165 children aged 8–12 with mood disorders. The children were using an average of two services, with pharmacotherapy and school services as most frequent. Children with bipolar disorders used significantly more and higher quality services than children with depressive disorders. Parent knowledge of mood disorders, area of residence, and perceived need for treatment were all related to the number of services families were utilizing. Parent knowledge of mood disorders and treatment, child’s age, and mood symptom severity were all predictors of the quality of services being utilized. Findings highlight the impact of non-need factors on service utilization and the potential to decrease disparities caused by these factors. For example, increasing efforts to educate both the general public and individual families coming in for treatment about children’s mental health may improve service utilization patterns in this population.


Children Mental health Service utilization 


  1. Andersen, R. M. (1968). Behavioral model of family’s use of health services. research series No. 25. Chicago, IL: Center for Health Administration Studies, University of Chicago.Google Scholar
  2. Andersen, R., & Davidson, P. (2001). Improving access to care in America. Individual and contextual indicators. In R. M. Andersen, T. H. Rice, & G. F. Kominski (Eds.), Changing the US health care system: Key issues in health services, policy, and management (pp. 3–30). San Francisco: Jossey-Bass.Google Scholar
  3. Andreasen, N. C., Endicott, J., Spitzer, R. L., & Winokur, G. (1977). The family history method using diagnostic criteria: reliability and validity. Archives of General Psychiatry, 24, 1229–1235.CrossRefGoogle Scholar
  4. Baker-Ericzén, M. J., Jenkins, M. M., & Brookman-Frazee, L. (2010). Clinician and parent perspectives on parent and family contextual factors that impact community mental health services for children with behavior problems. Child & Youth Care Forum, 39(6), 397–419.CrossRefGoogle Scholar
  5. Biederman, J., Mick, E., Prince, J., Bostic, J. Z., Wilens, T. E., Spencer, T., et al. (1999). Systematic chart review of the pharmacologic treatment of comorbid attention deficit hyperactivity disorder in youth with bipolar disorder. Journal of Child and Adolescent Psychopharamacology, 9, 247–256.CrossRefGoogle Scholar
  6. Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., et al. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 960–970.PubMedCrossRefGoogle Scholar
  7. Costello, E. J., Gordon, P., Keeler, M. S., & Angold, A. (2001). Poverty, race/ethnicity, and psychiatric disorder: A study of rural children. American Journal of Public Health, 91(9), 1494–1498.PubMedCrossRefGoogle Scholar
  8. Davidson, K. H., & Fristad, M. A. (2006). The Treatment Beliefs Questionnaire (TBQ): An instrument to assess beliefs about children’s mood disorders and concomitant treatment needs. Psychological Services, 3, 1–15.CrossRefGoogle Scholar
  9. Deveaugh-Geiss, J., March, J., Shapiro, M., Andreason, P. J., Emslie, G., Ford, L. M., et al. (2006). Child and adolescent psychopharmacology in the new millennium: A workshop for academia, industry, and government. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 261–270.PubMedCrossRefGoogle Scholar
  10. Federal Interagency Forum on Child and Family Statistics. (2010). America’s children in brief: Key national indicators of well-being, 2010. Washington, DC: U.S. Government Printing Office.Google Scholar
  11. Fristad, M. A., Gavazzi, S. M., & Mackinaw-Koons, B. (2003). Family psychoeducation: An adjunctive intervention for children with bipolar disorder. Biological Psychiatry, 53, 1000–1008.PubMedCrossRefGoogle Scholar
  12. Fristad, M. A., Verducci, J. S., Walters, K., & Young, M. E. (2009). The impact of multifamily psychoeducational psychotherapy in treating children aged 8–12 with mood disorders. Archives of General Psychiatry, 66, 1013–1021.PubMedCrossRefGoogle Scholar
  13. Gavazzi, S. M., Fristad, M. A., & Law, J. C. (1997). The understanding mood disorders questionnaire. Psychological Reports, 81, 172–174.PubMedGoogle Scholar
  14. Goldberg-Arnold, J. S., Fristad, M. A., & Gavazzi, S. M. (1999). Family psychoeducation: Giving caregivers what they want and need. Family Relations: Interdisciplinary Journal of Applied Family Studies, 48, 411–417.CrossRefGoogle Scholar
  15. Gyamfi, P. (2004). Children with serious emotional disturbance: The impact of poverty and receipt of public assistance on behavior, functioning, and service use. Children and Youth Services Review, 26, 1129–1139.CrossRefGoogle Scholar
  16. Harter, S. (1985). Manual for the social support scale for children. Denver, CO: University of Denver.Google Scholar
  17. Hurlburt, M. S., Leslie, L. K., Landsverk, J., Barth, R. P., Burns, B. J., Gibbons, R. D., et al. (2004). Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry, 61, 1217–1224.PubMedCrossRefGoogle Scholar
  18. Kerkorian, D., McKay, M., & Bannon, W. M. (2006). Seeking help a second time: parents’/caregivers’ characterizations of previous experiences with mental health services for their children and perceptions of barriers to future use. American Journal of Orthopsychiatry, 76, 161–166.PubMedCrossRefGoogle Scholar
  19. Knitzer, J., Steinberg, A., & Fleisch, B. (1990). At the schoolhouse door: An examination of progress and policies for children with behavioral and emotional problems. New York: Bank Street College of Education.Google Scholar
  20. Lagace, D. C., & Kutcher, S. P. (2005). Academic performance of adolescents with bipolar disorder. Directions in Psychiatry, 25, 111–117.Google Scholar
  21. Mendenhall, A. N., Davidson, K. H., & Fristad, M. A. (2010). The service provider and medication usage grids: A new method to measure “Treatment as Usual” (TAU). Child and Adolescent Social Work Journal, 27, 423–434.CrossRefGoogle Scholar
  22. Mendenhall, A. N., Demeter, C., Findling, R. L., Frazier, T. W., Fristad, M. A., Youngstrom, E. A., et al. (in press). Factors influencing mental health service utilization by children with serious emotional and behavioral disturbance: results from the LAMS study. Psychiatric Services. Google Scholar
  23. Mendenhall, A. N., Fristad, M. A., & Early, T. J. (2009). Factors influencing service utilization and mood symptom severity in children with mood disorders: effects of multi-family psychoeducation groups (MFPG). Journal of Consulting and Clinical Psychology, 77, 463–473.PubMedCrossRefGoogle Scholar
  24. Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 731–738.PubMedCrossRefGoogle Scholar
  25. Pandiani, J. A., Banks, S. M., Simon, M. M., Van Vleck, M. C., & Pomeroy, S. M. (2005). Access to child and adolescent mental health services. Journal of Child and Family Studies, 14, 431–441.CrossRefGoogle Scholar
  26. Peele, P. B., Axelson, D. A., Xu, Y., & Malley, E. (2004). Use of medical and behavioral health services by adolescents with bipolar disorder. Psychiatric Services, 55, 1392–1396.PubMedCrossRefGoogle Scholar
  27. Poznanski, E. O., Grossman, J. A., Buchsbaum, Y., Banegas, M., Freeman, L., & Gibbons, R. (1984). Preliminary studies of the reliability and validity of the children’s depression rating scale. Journal of the American Academy of Child Psychiatry, 23, 191–197.PubMedCrossRefGoogle Scholar
  28. Rizzo, C. J., Esposito-Smythers, C., Swenson, L., Birmaher, B., Ryan, N., Strober, M., et al. (2007). Factors associated with mental health service utilization among bipolar youth. Bipolar Disorder, 9, 839–850.CrossRefGoogle Scholar
  29. Sears, S. F., Evans, G. D., & Kuper, B. D. (2003). In B. H. Stamm (Ed.), Rural behavioral health care: An interdisciplinary guide (pp. 109–120). Washington, DC: American Psychological Association.Google Scholar
  30. Teich, J. L., Buck, J. A., Graver, L., Schroeder, D., & Zheng, D. (2003). Utilization of public mental health services by children with serious emotional disturbances. Administration and Policy In Mental Health, 30, 523–534.PubMedCrossRefGoogle Scholar
  31. Weller, E. B., Weller, R. A., Fristad, M. A., Rooney, M. T., & Schecter, J. (2000). Children’s interview for psychiatric syndromes. (ChIPS). Journal of the American Academy of Child and Adolescent Psychiatry, 39(1), 76–84.PubMedCrossRefGoogle Scholar
  32. Weller, E. B., Weller, R. A., Rooney, M. T., & Fristad, M. A. (1999a). Children’s interview for psychiatric syndromes (ChIPS). Washington, D.C.: American Psychiatric Press, Inc.Google Scholar
  33. Weller, E. B., Weller, R. A., Rooney, M. T., & Fristad, M. A. (1999b). Children’s interview for psychiatric syndromes, parent version (P-ChIPS). Washington, D.C.: American Psychiatric Press, Inc.Google Scholar
  34. Wu, P., Hoven, C. W., Cohen, P., Liu, X., Moore, R. E., Tiet, Q., et al. (2001). Factors associated with use of mental health services for depression by children and adolescents. Psychiatric Services, 52, 189–195.PubMedCrossRefGoogle Scholar
  35. Yeh, M., McCabe, K., Hough, R. L., Lau, A., Fakhry, F., & Garland, A. (2005). Why bother with beliefs? Examining relationships between race/ethnicity, parental beliefs about causes of child problems and mental health service use. Journal of Consulting and Clinical Psychology, 73, 800–807.PubMedCrossRefGoogle Scholar
  36. Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity, and sensitivity. British Journal of Psychiatry, 133, 429–435.PubMedCrossRefGoogle Scholar
  37. Youngstrom, E. A., Danielson, C. K., Findling, R. L., Gracious, B. L., & Calabrese, J. R. (2002). Factor structure of the young mania rating scale for use with youths ages 5–17 years. Journal of Clinical Child and Adolescent Psychology, 31(4), 567–572.PubMedGoogle Scholar
  38. Zwaanswijk, M., Van Der Ende, J., Verhaak, P., Bensing, J. M., & Verhulst, F. C. (2003). Factors associated with adolescent mental health service need and utilization. Journal of the Academy of Child & Adolescent Psychiatry, 42, 692–700.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.School of Social WelfareUniversity of KansasLawrenceUSA

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