Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

Patterns of Public Mental Health Service Use by Age in Patients With Schizophrenia

Perceived Need for Mental Health Care and Service Use Among Adults in Western Europe: Results of the ESEMeD Project

This study compared the prevalence of depression and the determinants of mental health service use in Canada and the United States. The study used data from preliminary analyses of the 2003 Joint Canada/United States Survey of Health, which measured Canadian (N=3,505) and United States (N=5,183) resident ratings of health and health care services. Cross-national comparisons were made for the 12-month prevalence of DSM-IV major depression, 12-month service use for mental health reasons according to the type of professional seen, and determinants of service use. The rates of depression were similar in Canada (8.2%) and the United States (8.7%). However, U.S. respondents without medical insurance were twice as likely as Canadian respondents and U.S. respondents with medical insurance to meet the criteria for depression. Rates of mental health service use did not differ between Canada (10.1%) and the United States (10.6%). In the United States, medical insurance was not a determinant factor of service use. However, U.S. respondents with no medical insurance were more likely than the other two groups to report an unmet need. Also, among those with depression, U.S. respondents with no medical insurance were less likely to use any type of mental health service (36.5%) than U.S. respondents with medical insurance (55.7%) and Canadians (55.7%). Further, a positive correlation between a mental health need and service use was observed in Canada but not for those without medical insurance in the United States. There was no difference in the prevalence of depression and mental health service use between Canada and the United States. Among those with depression, however, disparities in treatment seeking were found to be associated with medical insurance in the United States. Both Canada and the United States need to improve access to health services for those with mental disorders, and special attention is needed for those without medical insurance in the United States.

This study assessed patterns of mental health service use among adolescents who had attempted suicide and examined factors associated with their service use at individual, family, and community levels. Bivariate and multiple logistic regression analyses were conducted with data from 877 adolescents aged 12-17 who had attempted suicide in the past 12 months and who participated in the 2000 National Household Survey on Drug Abuse. Of the 877 adolescents, less than half (45%) reported that they had used mental health services in the past 12 months. Adolescents from racial-ethnic minority groups were less likely than whites to receive inpatient or outpatient mental health treatment, even when the analyses controlled for other demographic, individual, and family and community characteristics. Poor self-perceived health and living in a single-parent family were associated with use of inpatient services. Female gender, higher family income, participation in extracurricular activities, and the presence of symptoms of anxiety or disruptive disorders were associated with use of outpatient services. Use of school-based mental health services was associated only with participation in extracurricular activities. The mental health service needs of suicidal adolescents, especially those from ethnic minority groups and lower-income families, too frequently remain unmet. Larger racial-ethnic disparities were found in use of inpatient and outpatient mental health services than in use of school-based services. Mental health services offered within school settings can reach suicidal adolescents who need services but may experience barriers to standard types of care.

Evidence suggests that despite higher rates of mental health service use, sexual minority youth (SMY) have greater unmet mental health need than peers. Using a representative subsample of students with a mental health need from the National Longitudinal Study of Adolescent Health (n = 8,034), a multilevel analysis was conducted to explore whether: (1) Availability of school mental health services affects the odds that youth with a mental health need will use mental health services; and whether (2) sexual minority status (SMS) interacts with availability of school mental health services to moderate the relationship between SMS and mental health service use. SMY accounted for 10.3 % (n = 766) of the subsample. Mental health need was defined using measures for physical and sexual victimization, anxiety, depression, and suicidality. A hierarchical logistical regression tested for cross-level interaction (SMS × school mental health services). SMY had 82 % higher odds of using mental health services in any sector than their heterosexual peers (OR = 1.82, p < .001). Overall, youth with a mental health need had 40 % higher odds of using any type of mental health services if they attended schools offering mental health services (OR = 1.40, p < .001). The cross-level interaction test between SMS and service use was nonsignificant. Model-predicted probabilities are presented to better understand the findings. School-based mental health services are a crucial gateway to mental health service use in any sector for youth with a mental health need regardless of SMS.

The Role of Social Network and Support in Mental Health Service Use: Findings From the Baltimore ECA Study

Patterns of Public Mental Health Service Use by Age in Patients With Schizophrenia

Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

The high rate of co-occurring mental health issues and substance-use disorders has been well documented. The primary objective of this research was to evaluate the association between use of alcohol, marijuana, and other illicit drugs, and unmet mental health need and service use. A secondary aim of this research was to determine if the observed patterns of alcohol, marijuana, and other illicit drugs use and unmet mental health need and mental health service use are consistent with a theory of self-medication theory. On the latter view, people use psychoactive substances as a self-regulation strategy to alleviate distress. Research was conducted through secondary analysis of 2014 National Survey on Drug Use and Health (NSDUH) data. Overall, study findings supported the established correlation between mental health issues and substance use as well as a theory of self-medication. This study focused on people 18-25 years of age.

Despite the rapid growth of the Latino population in the child welfare system and the high rate of mental health need among children involved with this system, little is known about the mental health needs or use of mental health services among Latino children of immigrants involved with this system. Further, little is known about how the need for mental health services or use of those services differs from children of U.S.-born Latinos. This study analyzes data from the National Survey of Child and Adolescent Well-being (NSCAW) to identify the need for mental health services, mental health service use, and unmet mental health needs among Latino children of immigrants involved in the child welfare system, and compares those factors to those of children in U.S.-born Latino families. Findings indicate that significant differences are present, both in the need for mental health services and the use of those services. Awareness of these differences is necessary to effectively respond to the unique needs and experiences of Latino immigrant children and families who come to the attention of the child welfare system.

Latino families may be at risk of experiencing stressors resulting from the immigration process, such as those related to documentation status and acculturation, that may increase their need for mental health services. However, little research exists on the mental health needs and service use of Latino children. This study examined how parental nativity and legal status influence mental health needs and service utilization among children in Latino families investigated by child welfare. Data from the second National Survey of Child and Adolescent Well-Being, a nationally representative, prospective study of families investigated by child welfare agencies for maltreatment, were used to examine mental health need and service use in a subset of Latino children who remained in the home following a maltreatment investigation (N=390). Although children of immigrants did not differ from children of U.S.-born parents in levels of clinical need, they had lower rates of mental health service receipt. After the analyses accounted for other relevant variables, the odds of receiving services were significantly lower (odds ratio=.09) for children whose parents were undocumented compared with children whose parents were U.S. citizens. This study contributes to growing discourse on Latino family needs within the child welfare system. Analyses support earlier research regarding the effects of parent nativity on mental health service use and advance the literature by identifying parent legal status as a unique barrier to child service receipt.

Background: Unmet mental health needs can lead to worsening outcomes in youth. Given that youth depend on family for access to mental health services, and positive family functioning is associated with improved health outcomes, understanding the association between family-level factors and youth’s unmet mental health needs is essential to inform inclusive solutions. Objective: This study aimed to examine the association between family functioning (parental aggravation, parent-child communication, family resilience) and unmet mental health needs among school-aged youth. Methods: A cross-sectional analysis of the combined 2019-2020 National Survey on Children’s Health (NSDH) dataset was performed (n=9,204). Bivariate and multivariate logistic regression models were used to examine the association between unmet mental health needs (primary outcome) and family functioning using three explanatory variables, parental aggravation, parent-child communication, and family resilience. We also examined age-related differences in these associations between children aged 6-11 and adolescents aged 12-17. Results: The weighted proportion of youth with reported unmet mental health needs was 18%. Weighted unadjusted analyses showed that low family resilience was associated with 60% higher odds of unmet mental health needs, while parental aggravation and poor parentchild communication were not associated with unmet mental health needs. After adjusting for potential confounders, low family resilience was associated with 50% higher odds of unmet mental health needs among school-aged youth (AOR=1.54, 95% CI: 1.15-2.07). Being Black (AOR=2.28, 95% CI: 1.41-3.69), younger (AOR=0.95, 95% CI: 0.91-0.99), lacking consistent health insurance (AOR=2.64, 95% CI: 1.59-4.38), and having a mother with poor maternal health (AOR=1.82, 95% CI: 1.36-2.46), were also associated with unmet mental health needs. Among children aged 6-11 years, low family resilience, being Black, lacking consistent insurance, and having a mother with poor maternal health were associated with unmet mental health needs (all p’s&lt;0.05). Similarly, among adolescents aged 12-17 years, low family resilience, being Black, lacking consistent insurance, and having a mother with poor maternal health were associated with unmet mental health needs (all p&lt;0.05). Having a parent with a college education was associated with lower odds of unmet mental health needs among children (6-11 years), but not adolescents (12-17 years). Conclusion: Our findings have suggested an association between low family resilience and unmet mental health needs among school-aged youth. Since families are an integral part of meeting youth’s needs, applying approaches to addressing unmet mental health needs that consider family resilience and parental well-being is imperative. Identifying and addressing factors contributing to unmet health needs barriers may help address existing racial disparities.

Objectives: The purpose of this study was to examine factors associated with the mental health service use of Latino and Asian immigrant elders. Adapting Andersen's behavioral health model of health service utilization, predisposing, enabling, and mental health need factors were considered as potential predictors for use of mental health services. Method: Data were drawn from a nationally representative dataset, the National Latino and Asian American Survey (NLAAS). Hierarchical logistic regression analyses of mental health service use were conducted for Latino (N = 290) and Asian (N = 211) immigrant elders. Results: For both groups of immigrant elders, poor self-rated mental health was associated with significantly greater mental health service use, even after controlling for all other variables. For Latinos, use of mental health services was significantly associated with both predisposing factors (being younger and female) and mental health need factors (having any mood disorders and poor self-rated mental health). Among Asians, only mental health need factors (having any mood disorders and poor self-rated mental health) significantly affected mental health service use. In addition, poor self-rated mental health mediated the association between mood disorders and mental health service use only in Latino immigrant elders. Conclusion: Results highlight an important role of self-rated mental health as a potential barrier in the use of mental health services, and suggest intervention strategies to enhance service use.

Background Sexual orientation differences in mental health service (MHS) use have been described before, but evidence from European settings is scarce, and little is known about unmet mental health needs (UMHN). This study examines sexual orientation differences in MHS use and UMHN and associated sociodemographic factors in a population-based sample of young adults in Sweden (aged 17-34). Methods We used data from the Pathways to Longitudinally Understanding Stress (PLUS) study (N = 2,126). We performed logistic regressions to model MHS use and UMHN, followed by a subgroup analysis of UMHN among those perceiving a need of MHS. We used interaction terms to understand if associations with sociodemographic factors (gender, age, educational level, income, employment status, household composition, urbanicity and country of birth) differed by sexual orientation and calculated expected proportions. Results Overall, 35% of sexual minorities had used MHS the previous year, compared to 20.2% of heterosexuals (OR = 1.52, 95%CI=1.17-1.96, p = 0.002). MHS use was more likely among females, those not employed, not living with a partner, or with low income and less likely for those with less education. UMHN were more likely among sexual minorities (17.6%) than heterosexuals (11.8%, OR = 1.47, 95%CI=1.09-2.00, p = 0.013). Overall, one-third of those with perceived need did not use services, with a significant interaction (p = 0.015) between sexual minority status and gender (60% of sexual minority males vs 36% of heterosexual males and 28% of sexual minority females). For both groups, UMHN were more likely among younger, low-educated and employed persons, and less likely among those with low income. Conclusions Sexual minorities are more likely to use MHS but present higher access barriers. Sexual minority men seem less likely to seek help for mental health symptoms. Future research should assess why that happens, while policies should promote friendly mental health services to this group.

Timely and appropriate treatment could help reduce the burden of mental illness. This study describes mental health services use among Californians with mental health need, highlights underserved populations, and discusses policy opportunities. Four years of California Health Interview Survey data (2011, 2012, 2013, 2014) were pooled and weighted to the 2013 population to estimate mental health need and unmet need (n=82,706). Adults with mental health need had "unmet need" if they did not use prescription medication and did not have at least four or more mental health visits in the past year. Multivariable logistic regression analysis was performed to predict the probability adults with mental health need did not receive past-year treatment (n=5,315). Seventy-seven percent of Californians with mental health need received no or inadequate mental health treatment in 2013. Men, Latinos, Asians, young people, older adults, people with less education, uninsured adults, and individuals with limited English proficiency were significantly more likely to have unmet need. Cost of treatment and mental health stigma were common reasons for lack of care. Unmet mental health need is predominant in California. Policy recommendations include continued expansion of mental health coverage, early identification, and ensuring that treatment is culturally and linguistically appropriate.