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National estimates of child mental health difficulties and service use: A public health approach

National estimates of child mental health difficulties and service use: A public health approach. Anna K. Falkenstern Maternal and Child Health Leadership Development Team April 1, 2005. Objectives. To frame children’s mental health (MH) problems as a public health issue

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National estimates of child mental health difficulties and service use: A public health approach

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  1. National estimates of child mental health difficulties and service use: A public health approach Anna K. Falkenstern Maternal and Child Health Leadership Development Team April 1, 2005

  2. Objectives • To frame children’s mental health (MH) problems as a public health issue • To describe the strengths and challenges of studying child psychiatric epidemiology • To examine the prevalence of child MH difficulties in major sociodemographic subgroups • To describe use of MH services among children with MH difficulties in a national sample

  3. Statement of the problem • One in five children meet criteria for a mental health (MH) disorder • 5% experience serious functional impairment • MH disorders often undetected and untreated • “No other illnesses damage so many children so seriously”-National Advisory MH Council’s Workgroup on Child and Adolescent MH

  4. Impact of unmet MH needs • Impaired functioning with family, school and peers • School drop out • Criminal activity • Suicide • Long-term MH and substance abuse problems • Additional social costs • Hospital and medical expenditures • Lost productivity

  5. Psychiatric epidemiology: Challenges • Population-based measurement of MH • Time • Cost • Measurement error • Symptoms versus diagnosis • Lack of national epidemiological data • Limited to clinic-based or community samples

  6. Measuring child MH problems: Challenges • Varying rates of childhood development • Criteria based on adults • Parental recognition and perceived burden • Stigma and fears about labeling • Multiple services and settings

  7. Child MH and public policy • US Surgeon General’s Children MH Action Agenda (2000): Increase access and coordination of quality MH services • President’s New Freedom Commission on Mental Health (2003): Eliminate disparities in the use of MH services • National health surveys may provide useful data for developing policies to improve services

  8. Methods • National Health Interview Survey (NHIS) • Annual, nationally representative • Civilian, noninstitutionalized U.S. population • In-personinterviews with a knowledgeable adult family member, usually a parent • Study sample: • Children 4-17 years of age • 2001-2003 NHIS child sample n=28,476

  9. Conceptual framework* Predisposing Factors Biology Demographic Health beliefs Need Mental health difficulties External Environment Physical Social Political Economic Health care system Policy Resources Organization Enabling Resources Family Community Use of health Services Mental health services *Adapted from Anderson (1995)

  10. Independent variables • Predisposing factors: Demographics • Age • Sex • Race/ethnicity • Enabling resources: Health insurance • None, public, private insurance

  11. Need: MH difficulties • Question from the Strengths and Difficulties Questionnaire (Goodman, 1994) “Overall, do you think that (sample child) has difficulties in any of the following areas: emotions, concentration, behavior, or being able to get along with other people?” • Response categories-Severe, definite, minor, or no difficulties

  12. Outcome: MH service use • MH professional • General doctor • Special Education

  13. Estimation and analysis procedures • Sample data weighted • Standard errors calculated with SUDAAN • Chi square tests and pairwise t tests • Odds ratios adjusted for confounders • Results are preliminary-please do not cite

  14. Prevalence of MH difficulties Overall: 5% of children (2.8 million) had definite/severe difficulties Age: Percentage of children with difficulties increased with age Sex: Boys were twice as likely as girls to have difficulties (6.6% vs. 3.5%)

  15. Prevalence of MH difficulties Race/ethnicity: Hispanic children were less likely to have reports of difficulties than NH white or NH black children Health insurance: Children with public health insurance were more likely to have difficulties than uninsured children or children with private insurance

  16. MH service use among childrenwith MH difficulties • 62% used at least one type of MH service: • 45% had contact with a MH professional • 39% had contact with a general doctor • 28% received special education • Use of services varied by sociodemographic factors

  17. Use of MH services among children with MH difficulties: Age Percent

  18. Use of MH services among children with MH difficulties: Sex Percent

  19. Use of MH services among children with MH difficulties: Race/ethnicity Percent

  20. Use of MH services among children with MH difficulties: Health insurance Percent

  21. Adjusted1 odds ratio of use of MH services: Age 1Adjusted for child’s sex, race/ethnicity, family structure, health insurance, and residential location

  22. Adjusted1 odds ratio of use of MH services: Sex 1Adjusted for child’s age, race/ethnicity, family structure, health insurance, and residential location

  23. Adjusted1 odds ratio of use of MH services: Race/ethnicity NH – non-Hispanic 1Adjusted for child’s sex, age, family structure, health insurance, and residential location

  24. Adjusted1 odds ratio of use of MH services: Health insurance 1Adjusted for child’s sex, age, race/ethnicity, family structure, and residential location

  25. Social work role Multi-level Interventions: • Micro: Individual and family practice • Case management and psychotherapy • Focus on prevention and early identification • Macro: Policy development and advocacy • Mental health parity and coordination of services • Coordination of systems of care • Integration of policy, research, and practice

  26. Study limitations • Based on parental report at a single point in time • Measures based on single questions • Only current health insurance was assessed • Institutionalized population not included

  27. Conclusion: Key points • A substantial portion of children with MH difficulties do not receive MH services • Independent differences in MH service use by health insurance, age, sex, and race/ethnicity • Public health insurance and school services reduce barriers to MH care • National epidemiological data can inform MH policy analysis and planning

  28. Additional Information • The National Health Interview Survey (NHIS): http://www.cdc.gov/nchs/nhis.htm • Strengths and Difficulties Questionnaire: www.sdqinfo.com • America's Children, a publication of the Federal Interagency Forum on Child and Family Statistics: http://childstats.gov

  29. Acknowledgements • Patricia Pastor, PhD, Cynthia Reuben, MA, and Susan Lukacs, MD, National Center for Health Statistics, Centers for Disease Control and Prevention

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