Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Suicide in Young Adults

Gender Differences in Suicidal Adolescents' Mental Health Service Use: Analysis of a National Survey

Purpose: More than 4,000 U.S. youth die by suicide every year and millions more think about or attempt suicide, yet few suicidal youth receive professional help. Even though substantial disparities exist in boys' and girls' rates of suicidal behavior and mental health service use in general, research has neglected whether these differences apply specifically to service use by suicidal youth. This study sought to identify specific demographic, financial, and psychosocial factors, including interactions with gender, increasing the likelihood of mental health service use among boys and girls reporting suicidality.

Methods: The study used secondary data from 19,430 youth ages 12-17 in the 2000 National Household Survey on Drug Abuse, which collected data on numerous psychosocial characteristics and mental health service use. Analyses focused only on youth reporting suicidal thoughts or attempts in the previous year. Using the Andersen behavioral model of healthcare utilization as an organizing framework, the secondary analyses examined factors that potentially predisposed suicidal youth to service utilization (age, race, religiosity), enabled service use (insurance coverage, family income, urban or rural status), and increased the need for help (substance use, mood, anxiety, and conduct disorder symptoms). In preliminary analyses, chi-square and t-tests examined bivariate relationships with service use, and separate logistic regressions included gender, each variable singly, and the interaction term. Logistic regression models stratified by gender included variables significant in bivariate analyses, as well as age, race, income, and insurance as control variables. Finally, all significant main and interactive effects, gender, and control variables comprised an overall logistic regression model predicting suicidal youth's receipt of mental health services.

Results: Only 35% of the 2,386 youth reporting suicidality during the prior year received professional help for mental health problems. Girls' rates of suicidality almost doubled those of boys (16.1% vs. 8.5%), but service use rates did not significantly differ. For both boys and girls, a substance use disorder, conduct disorder symptoms, and arrest history increased the odds, and Hispanic ethnicity decreased the odds, of suicidal youth's service use. For boys only, anxiety symptoms and poor health also predicted service use. For girls only, significant predictors additionally included mood disorder symptoms, attention deficit disorder symptoms, white race, and a single-parent home. Notably, insurance coverage, income, urban residence, and religiosity did not differentiate service users from non-users. The overall model showed that suicidal girls were more likely than suicidal boys to use mental health services, after controlling for the various predisposing, enabling, and need factors, but that black race and gender interacted to diminish significantly the odds of service use for black girls.

Implications for practice or policy: To more effectively increase help-seeking and help prevent suicide, policymakers need to address gender and racial disparities in suicidal adolescents' use of mental health services. Low rates of service use among both genders deserve attention from researchers and policymakers, and practitioners need to be aware of the different psychosocial problems they may commonly encounter in male and female youth with suicidality.

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