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Contextual Socioeconomic Status and Mental Health Counseling Use Among US Adolescents with Depression

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Abstract

Most adolescents with depressive disorders do not receive any mental health services, even though effective treatments exist. Although research has examined numerous individual-level factors associated with mental health service use among depressed adolescents, less is known about the role of contextual factors. This study examines the relationship between contextual-level socioeconomic status (SES) and clinic-based mental health counseling use among US adolescents with high depressive symptoms in urban and suburban areas. Data from the first two waves of the National Longitudinal Study of Adolescent Health (N = 1,133; 59 % female) were analyzed using multilevel logistic models in which adolescents were nested within counties. After controlling for individual-level predisposing, enabling, and need characteristics, as well as county racial/ethnic composition, county SES was positively associated with clinic-based counseling use among depressed youth. A one standard deviation increase in the county affluence index was associated with 43 % greater odds of receiving any clinical counseling services. Furthermore, the positive relationship between county affluence and clinical counseling use was no longer significant after controlling for the county supply of mental health specialist physicians. The results indicate that county residential context is a key correlate of mental health service use among depressed adolescents, such that those who live in lower SES counties with fewer mental health specialists are less likely to receive treatment.

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References

  • Acevedo-Garcia, D., & Lochner, K. A. (2003). Residential Segregation and Health. In I. Kawachi & L. F. Berkman (Eds.), Neighborhoods and health (pp. 265–287). Oxford: Oxford University Press.

    Chapter  Google Scholar 

  • American Academy of Child and Adolescent Psychiatry. (2013). Practice parameter for cultural competence in child and adolescent psychiatry. Accessed on August 16, 2013, available at http://www.aacap.org/App_Themes/AACAP/Docs/practice_parameters/Cultural_Competence_Web.pdf.

  • Andersen, R., & Davidson, P. (2001). Improving access to care in America. In R. Andersen, T. Rice, & G. Kominsky (Eds.), Changing the US health care system (pp. 3–30). San Francisco: Jossey-Bass.

    Google Scholar 

  • Aneshensel, C. S., & Sucoff, C. A. (1996). The neighborhood context of adolescent mental health. Journal of Health and Social Behavior, 37(4), 293–310.

    Article  PubMed  Google Scholar 

  • Area Resource File (ARF). (2008). Rockville. MD: US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions.

  • Beyers, J. M., Bates, J. E., Pettit, G. S., & Dodge, K. A. (2003). Neighborhood structure, parenting processes, and the development of youths’ externalizing behaviors: a multilevel analysis. American Journal of Community Psychology, 31(1–2), 35–53.

    Article  PubMed  PubMed Central  Google Scholar 

  • Birmaher, B., Brent, D., Bernet, W., Bukstein, O., Walter, H., Benson, R. S., et al. (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1503–1526.

    Article  PubMed  Google Scholar 

  • Botticello, A. L. (2009). School contextual influences on the risk for adolescent alcohol misuse. American Journal of Community Psychology, 43(1–2), 85–97.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brener, N. D., Martindale, J., & Weist, M. D. (2001). Mental health and social services: Results from the School Health Policies and Programs Study 2000. Journal of School Health, 71(7), 305–312.

    Article  PubMed  Google Scholar 

  • Cauce, A. M., Domenech-Rodriguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., et al. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2012). Youth suicide. Accessed on June 17, 2012, available at http://www.cdc.gov/ViolencePrevention/pub/youth_suicide.html.

  • Collins, L. M., Schafer, J. L., & Kam, C. M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6(4), 330–351.

    Article  PubMed  Google Scholar 

  • Cook, B. L., Doksum, T., Chen, C. N., Carle, A., & Alegria, M. (2013). The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the US. Social Science and Medicine, 84, 102–109.

    Google Scholar 

  • Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625.

    Article  PubMed  Google Scholar 

  • Costello, E., Mustillo, S., Keeler, G., & Angold, A. (2004). Prevalence of psychiatric disorders in childhood and adolescence. In B. Levin, J. Petrila, & K. Hennessy (Eds.), Mental health services: A public health perspective (pp. 111–128). Oxford: Oxford University Press.

    Google Scholar 

  • Cummings, J. R., & Druss, B. G. (2011). Racial/ethnic differences in mental health service use among adolescents with major depression. Journal of the American Academy of Child and Adolescent Psychiatry, 50(2), 160–170.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fergusson, D., & Woodward, L. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59(3), 225–231.

    Article  PubMed  Google Scholar 

  • Fletcher, J. M. (2008). Adolescent depression: Diagnosis, treatment, and educational attainment. Health Economics, 17, 1215–1235.

    Article  PubMed  Google Scholar 

  • Fortney, J., Rost, K., Zhang, M., & Warren, J. (1999). The impact of geographic accessibility on the intensity and quality of depression treatment. Medical Care, 37(9), 884–893.

    Article  PubMed  Google Scholar 

  • Goodman, S. H., Schwab-Stone, M., Lahey, B. B., Shaffer, D., & Jensen, P. S. (2000). Major depression and dysthymia in children and adolescents: Discriminant validity and differential consequences in a community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 39(6), 761–770.

    Article  PubMed  Google Scholar 

  • Goodman, E., & Whitaker, R. C. (2002). A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics, 110(3), 497–504.

    Article  PubMed  Google Scholar 

  • Gresenz, C. R., Stockdale, S. E., & Wells, K. B. (2000). Community effects on access to behavioral health care. Health Services Research, 35(1 Pt 2), 293–306.

    PubMed  PubMed Central  Google Scholar 

  • Health Resources and Services Administration. (2011). National health service corps loan repayment. Accessed on September 1, 2011, available at http://nhsc.hrsa.gov/loanrepayment/.

  • 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(12), 1217–1224.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kelch, D. R. (2011). The crucial role of counties in the health of Californians: An overview. Oakland: California Healthcare Foundation.

    Google Scholar 

  • Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., et al. (1996). The role of black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine, 334(20), 1305–1310.

    Article  PubMed  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1998). Major depressive disorder in older adolescents: prevalence, risk factors, and clinical implications. Clinical Psychology Review, 18(7), 765–794.

    Article  PubMed  Google Scholar 

  • Lo Sasso, A. T., & Byck, G. R. (2010). Funding growth drives community health center services. Health Affairs (Millwood), 29(2), 289–296.

    Article  Google Scholar 

  • Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the national comorbidity Survey replication–adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in US adolescents: Results of the national comorbidity survey-adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45.

    Article  PubMed  Google Scholar 

  • Michael, K. D., & Crowley, S. L. (2002). How effective are treatments for child and adolescent depression?: A meta-analytic review. Clinical Psychology Review, 22(2), 247–269.

    Article  PubMed  Google Scholar 

  • National Association of Community Health Centers. (2010). NACHC health reform hub. Accessed on 23 March 2010, available at http://www.nachc.com/healthreform.cfm.

  • Olfson, M., Gameroff, M. J., Marcus, S. C., & Waslick, B. D. (2003). Outpatient treatment of child and adolescent depression in the United States. Archives of General Psychiatry, 60(12), 1236–1242.

    Article  PubMed  Google Scholar 

  • Pescosolido, B. A., Perry, B. L., Martin, J. K., McLeod, J. D., & Jensen, P. S. (2007). Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services (Washington, DC), 58(5), 613–618.

    Article  Google Scholar 

  • Radloff, L. S. (1977). The CES-D: A self-report depression scale for research in the general population. Applied Psychological Measurement, I, 385–401.

    Article  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Heirarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Roberts, R. E., Lewinsohn, P. M., & Seeley, J. R. (1991). Screening for adolescent depression: a comparison of depression scales. Journal of the American Academy of Child and Adolescent Psychiatry, 30(1), 58–66.

    Article  PubMed  Google Scholar 

  • Rosko, M. D., & Broyles, R. W. (1988). The economics of health care: A reference handbook. New York: Greenwood Press.

    Google Scholar 

  • SAMHSA. (2009). The NSDUH report: Major depressive episode and treatment among adolescents. Office of applied studies, substance abuse and mental health services administration.

  • Siegel, J. M., Aneshensel, C. S., Taub, B., Cantwell, D. P., & Driscoll, A. K. (1998). Adolescent depressed mood in a multiethnic sample. Journal of Youth and Adolescence, 27(4), 413–427.

    Article  Google Scholar 

  • Slade, E. P. (2002). Effects of school-based mental health programs on mental health service use by adolescents at school and in the community. Mental Health Services Research, 4(3), 151–166.

    Article  PubMed  Google Scholar 

  • Snijders, T., & Bosker, R. (1999). Multilevel analysis: An introduction to basic and advanced multilevel modeling. London: Sage Publications.

    Google Scholar 

  • Stata Corporation. (2007). Stata Statistical Software (release 10.0). College Station, TX.

  • Substance Abuse and Mental Health Services Administration. (2013). Report to congress on the nation’s substance abuse and mental health workforce issues. US Department of Health and Human Services.

  • Thomas, C. P., Conrad, P., Casler, R., & Goodman, E. (2006). Trends in the use of psychotropic medications among adolescents, 1994 to 2001. Psychiatric Services (Washington, DC), 57(1), 63–69.

    Article  Google Scholar 

  • Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services (Washington, DC), 60(10), 1323–1328.

    Article  Google Scholar 

  • US Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity. A Supplement to mental health: A report of the surgeon general. Washington DC: US Government Printing Office.

  • Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., et al. (1999). Depressed adolescents grown up. The Journal of the American Medical Association, 281(18), 1707–1713.

    Article  Google Scholar 

  • Wight, R. G., Aneshensel, C. S., Botticello, A. L., & Sepulveda, J. E. (2005). A multilevel analysis of ethnic variation in depressive symptoms among adolescents in the United States. Social Science and Medicine, 60(9), 2073–2084.

    Article  PubMed  Google Scholar 

  • Wight, R. G., Cummings, J. R., Miller-Martinez, D., Karlamangla, A. S., Seeman, T. E., & Aneshensel, C. S. (2008). A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life. Social Science and Medicine, 66(4), 862–872.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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 (Washington, DC), 52(2), 189–195.

    Article  Google Scholar 

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Acknowledgments

This work was supported by the National Institute of Mental Health (F31MH083328; 1K01MH09582301). The author is grateful for the helpful comments and suggestions of Ninez Ponce, Carol Aneshensel, Richard Wight, Benjamin Druss, Michelle Ko, Neetu Chawla, and Lindsay Allen. This research uses data from Add Health, a program Project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by Grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from Grant P01-HD31921 for this analysis.

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  1. Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Suite 650, Atlanta, GA, 30322, USA

    Janet R. Cummings

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Cummings, J.R. Contextual Socioeconomic Status and Mental Health Counseling Use Among US Adolescents with Depression. J Youth Adolescence 43, 1151–1162 (2014). https://doi.org/10.1007/s10964-013-0021-7

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