Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury

Background and Purpose: Utilization of mental health services and other rehabilitation services after traumatic brain injury (TBI) can significantly improve functional outcomes. Yet, availability of rehabilitation services, particularly mental health services, is limited for children with Medicaid insurance and those in need of language interpretation, despite the fact that there is no evidence these children have lower rates of mental health service needs. However, to date, racial variation in mental health service utilization of hospitalized children after TBI has not been documented. In this study, among children insured by Medicaid, we compared mental health service utilization between children of different racial/ethnic backgrounds. We hypothesized that children from racial minority groups would have lower rates of outpatient mental health service utilization compared to their non-Hispanic White (NHW) peers. 

Methods: This was a retrospective analysis of the Truven Health Analytics MarketScan® Multi-State Medicaid database from 2007-2012. Outpatient mental health service utilization (psychiatric and psychological individual and group services) was compared at TBI hospitalization, from discharge to 3 months and from 4 to 12 months after discharge between children of non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic and “Other” racial groups. Multivariable mixed effects Poisson regression models with robust standard errors were utilized.

Results: A total of 5,674 children (<21 years) were included in the study. There were no differences by race/ethnicity in mental health service utilization during hospitalization. At 3 months post discharge, NHB children and children in the “Other” racial category were significantly less likely to receive outpatient mental health services compared to NHW children (NHB RR=0.84; 95%CI:0.72-0.98; Other RR=0.72; 95%CI:0.57-0.90). At 12 months, all racial minority children were significantly less likely to receive outpatient mental health services compared to NHW children (NHB RR=0.84, 95%CI:0.76-0.94; Hispanic RR=0.73, 95%CI:0.55-0.95; Other RR=0.71, 95%CI:0.60-0.84).

Implications: Racial disparities in utilization of subsequent outpatient mental health services exist for minority children hospitalized for TBI and insured by Medicaid. Future research should focus on improving transitions of care from inpatient to outpatient services for these children.