Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral

<p>Abstract</p> <p>Background</p> <p>In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics.</p> <p>Methods</p> <p>The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses.</p> <p>Results</p> <p>Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral.</p> <p>Conclusions</p> <p>This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.</p

Rates, Associations, and Predictors of Psychopathology in a Convenience Sample of School-Aged Latino Youth: Identifying Areas for Mental Health Outreach

The Latino youth population is rapidly growing and expected to comprise nearly 40 % of the total youth population by 2060. Unfortunate disparities exist in the United States (U.S.), such that young Latinos are less likely than non-Hispanic Whites to receive and benefit from mental health services. In order to identify and prioritize specific areas of mental health outreach, the current study examined preliminary rates, associations, and predictors of child psychopathology in a convenience sample of Latino youth. 123 Spanish and English speaking Latino parents of school-aged children completed a series of questionnaires regarding child and family functioning. Latino youth in the current sample demonstrated comparable rates of psychopathology to non-referred, normative samples. Parental acculturation (particularly Separated parental acculturation status: high orientation to Latino culture and low orientation to U.S. mainstream culture) was associated with an increased prevalence of clinically significant psychopathology across several domains, and socioeconomic status was associated with an increased prevalence of thought problems. Additionally, Separated parental acculturation status significantly predicted the prevalence of clinically significant anxious/depressed problems, such that youth of parents displaying Separated acculturation status were significantly more represented in the clinically-elevated groups than the functional groups. These preliminary results suggest that prioritizing outreach to Latino youth of parents maintaining orientation to Latino culture but not U.S. mainstream culture may be necessary in order to begin addressing existing mental health disparities in the U.S