Predictors of Mental Health Service Utilization Among Latino High School Students and the Moderating Role of School Location

Background/Purpose: This study examined predictors of lifetime mental health (MH) service use in a sample of Latino high school students. Although existing research highlights multiple factors influencing service use among adults, less is known about which factors predict use among Latino adolescents. Guided by Andersen’s model of health service utilization, we tested predisposing, enabling, and need factors as predictors of MH service use. Furthermore, we explored the interaction effects of school location (in a high-immigration-enforcement versus a low-enforcement jurisdiction) and child nativity (U.S-born versus foreign-born) with lifetime service utilization. We hypothesized that youth in a high-enforcement context would have less access to MH services.

Methods: Data were collected during 2018–19 school year from 306 Latino students in 11 public and charter high schools located in Rhode Island (n= 154) and Harris County, Texas (n=152). MH service use was measured dichotomously, using a question asking students whether they talked to a psychologist/social worker/counselor about their problems in their lifetime. A binary logistic regression was run in SPSS to predict the probability of MH service use. Age, gender, and youth’ and mother’s country of origin were defined as predisposing factors; language proficiency, school location, and economic hardship as enabling factors; and exhibiting symptoms of at least one of three conditions (anxiety, depression, or PTSD) as a need factor. The model included an interaction effect between school location in a high versus low-enforcement jurisdiction and youth’s nativity.

Results: Seventy-eight percent of youth reported symptoms consistent with at least one MH condition. Lifetime MH service use was associated with the predisposing factors of being female (p=.034), being older (p =.002), and having a mother from South America (p =.002) as opposed to Central America, Mexico or the Caribbean. Among the enabling factors, economic hardship (p=.000) showed a significant association, but English language proficiency did not (p=.700). Perhaps importantly, lifetime service use was not associated with need as measured by meeting the criteria for a MH disorder (p=.187). A marginally significant interaction effect between school location and youth’s nativity (p=.080) was found, suggesting that U.S-born students in Harris County were three times more likely to have used services than foreign-born students in Harris County. No difference in MH use by nativity for students in Rhode Island was observed.

Conclusions: Predisposing factors were more strongly associated with MH services use than enabling or need factors. Andersen’s framework allowed us to identified the highest levels of unmet need among foreign-born youth, those with mothers born in Mexico, the Caribbean, and Central America, and those experiencing economic hardship. School location moderated use of services, with unmet need especially high among foreign-born youth in Harris County: the study site with a relatively high-level of immigration enforcement. These foreign-born youth may lack immigration status, be vulnerable to arrest and deportation, and therefore be afraid to access MH services. School-level and state-level policy recommendations to ensure equitable access to services among foreign and U.S.-born Latino youth in both high- and low-enforcement jurisdictions are highlighted.