Social Network Influences on Help-Seeking and Service Use among Urban Youth with Mental Health Problems

Background: Recent reports from the U.S. Surgeon General and Institute of Medicine indicate that African American adolescents, especially those residing in urban and high-stressed environments, are more likely to suffer from untreated mental health problems than their counterparts in the general population (USDHHS, 2001). Further, reports indicate that untreated mental health conditions may underlie problems associated with poor school performance, violence, and other forms of delinquency experienced by this group (Gonzales, 2005; Jenkins & Bell, 19970; Jones, 2007). Yet, there is limited information regarding factors associated with African American adolescents' lower participation in mental health services.

Research examining help-seeking behaviors and mental health service use among ethnic minorities indicates that pathways into mental health treatment are shaped not only by the type of problem experienced, but also by the support provided by social network members (Bussing et al., 2003; Pescosolido et al., 1998). In fact, individuals whose networks are larger are more likely to use family and friends, practitioners in the general health sector, and clergy when experiencing a mental health-related problem. These findings suggest that social networks may be instrumental for engaging youth in prevention/early intervention efforts.

The present study examined associations between the size and quality of African American adolescents' social networks and their mental health service use. The study also examined whether these social networks moderated the association between need for services due to emotional or behavioral difficulties and use of services. It was hypothesized that larger social networks and networks perceived to provide help and emotional aid would be associated with a decreased use of mental health services, even for youth in need of such services.

Methods: Participants were a community sample of African American adolescents (N=465; 46.2% female; mean age 14.78) initially recruited in 1st grade for participation in an evaluation of two preventive intervention trials (Ialongo, Werthamer, Kellam, et al, 1999). Teachers reported youths' need for services due to anxiety or depression, or due to behavior problems. Parents reported about their adolescents' use of mental health services in the past year. Adolescents reported on their social networks. ANCOVAs were used to examine associations between study variables.

Results: A significant positive association between adolescentsx perception social network helpfulness and their use of school mental health services was identified. The significant associations between need for services for anxiety, depression, or behavior problems, and school and outpatient service use were moderated by size of the social network. Specifically, among youth in need of services for anxiety or depression, school-based service use was significantly higher for those with larger social networks. For youth with aggressive, disruptive behavioral problems, outpatient service use reached a trend association (p=.07) among youth with larger social networks.

Conclusions/Implications: Findings provide important insights into the association between social network characteristics and African American adolescents' use of mental health services. Given the results of this study, community and school-based mental health practitioners should pay careful attention to incorporating social networks as potential facilitators to service use among African American adolescents with mental health needs.