(Converted as ePoster, See Poster Gallery) Understanding County-Level Relationships between Mental and Physical Distress, Service Availability, and Child Maltreatment Report Rates in the United States, 2014-2017

Background/Purpose:

Existing evidence based in large urban counties suggest that while mental/physical distress may increase child maltreatment risk, the presence of community services for these problems may have a protective function. We expanded these local findings to the nation including rural areas. We examined the relationships between rates of mental distress, physical distress, mental health provider (MHP), primary care physician (PCP), and child maltreatment report (CMR) at the county level in the United States from 2014–2017, overall and within urbanicity and demographic subgroups.

Methods:

We linked County Health Rankings, Census, and CMR data at the county level from 2014–2017. We obtained mental distress rates (% adults reporting ≥14 days of poor mental health per month), physical distress rates (% adults reporting ≥14 days of poor physical health per month), MHP rates (per 10,000 population), and PCP rates (per 10,000 population) from County Health Rankings. We examined both within-county longitudinal changes and between-county differences in these rates and estimated their associations with CMR rates (per 1,000 children), using within-between random effects models. Due to multicollinearity, we analyzed mental health variables and physical health variables separately. All estimates were adjusted for urbanicity and a range of confounders (i.e., median household income, % single parent, % Black, % Latino, % foreign-born, % child, % disability, and % moved).

Results:

A one-point increase in the within-county mental distress rate was significantly associated with a 0.78-point increase in the CMR rate (coefficient = 0.78, 95% CI = [0.22, 1.35]). Conversely, a one-point increase in the within-county MHP rate was significantly associated with a 0.36-point decrease in the CMR rate (-0.36 [-0.52, -0.21]). While these associations did not significantly vary by age and gender subgroups, variations by urbanicity and race/ethnicity exist. Compared with large urban counties, the within-county mental distress rates showed significantly larger associations among small urban (1.05 [0.28, 1.86]) and rural counties (2.18 [1.26, 3.09]). Within-county MHP rates were negatively associated CMR rates among White (-0.29 [-0.46, -0.13]) and Black (-0.90 [-1.38, -0.45]) children, but not among Latino children (0.14 [-0.13, 0.41]). Between-county rates of mental distress and MHP and all within/between-county rates of physical distress and PCP showed no significant association.

Conclusions/Implications:

In national county-level data, longitudinal increases in community mental distress were related to increased CMR rates, especially in small urban and rural counties. In contrast, longitudinal increases in MHP rates were related to decreased CMR rates in all counties. We further found that community physical distress and PCP rates had no significant association with CMR rates. Our findings support the generalizability of prior local findings and support increased attention to communities with high mental distress rates, especially for small urban and rural communities, and communities with low MHP rates. Further research is required to understand community-level risk and protective mechanisms of community mental distress and mental health services. Further research is also warranted to understand whether the non-significant protective association of increased MHP for Latino children is related to the accessibility of Latino populations to community mental health services.