Patterns of and Factors Associated with Mental Health Service Utilization Among School-Going Adolescent Girls in Southwestern Uganda: A Latent Class Analysis

Background: Adolescent mental health and well-being is important for overall health and is reliant on their access to and use of mental health services. Despite the high prevalence of neuropsychiatric illness among adolescents, many have virtually no treatment due to a lack of services and underutilization perpetuating disparities in access to mental health services. This study is guided by the behavioral model of healthcare utilization, which posits that healthcare utilization is influenced by three interrelated constructs including predisposing, enabling, and need factors. Therefore, this study aimed to describe patterns of the multiple family groups (MFG) intervention engagement among adolescents and explore predisposing, enabling, and need factors that influence the use of an evidence-based intervention among a random sample of adolescent girls in southern Uganda.

Method: The sample consisted of 317 adolescent girls (ages 14–17 at enrollment) recruited from senior one and senior two classes across 12 secondary schools in the southwestern region of Uganda. Participants in this study participated in the multiple family group intervention—16 weeks of a manualized intervention designed to improve family communication and support. In the present study, age, education level, religion, family size, number of children in the family, and residence were examined as predisposing factors. Enabling factors are family assets, self-reported health, quality of social support relationships, and distance to the school. Depressive symptoms of participants were examined as a need factor. Additionally, attendance data from 16 sessions were used to identify the heterogeneity of intervention engagement using Latent Class Analysis (LCA) modeling. Logistic regression analysis was conducted to assess the association between predisposing, enabling, need factors, and patterns of mental health utilization.

Results: At baseline, adolescent girls (n=317) were aged 15 years (SD=0.89) on average, and lived in families with an average of 7 adults (SD=2.9) and 3 children—below 18 years (SD=2.07). Moreover, a majority of the participants (64.98%, n=206) were in rural-based schools, locations that tend to report limited access to mental health services. Participants attended an average of ten multiple family group sessions, and 34.38% completed all 16 sessions. Using LCA, two groups were identified: low attendants and high attendants. In addition, two family-level factors, the number of adults (OR=1.08, 95% CI=1.00, 1.17, P<.05) and the number of children (OR=1.12, 95% CI=1.05, 1.19, P<.001) in the family, were associated with an increase in the utilization of mental health services.

Conclusions and implications: Findings suggest that engagement in family strengthening interventions (i.e. MFGs) is heterogeneous among adolescent girls and that enhancing family support systems may be useful to promote mental health utilization among adolescent girls. In addition, results provide support for the successful implementation of the MFG intervention in low-resource settings, which is essential to addressing disparities in mental health care. We found that adolescents with varying symptoms of depression and their families were engaged in the MFG intervention. Hence reducing barriers associated with access and use of the intervention could support the initiation, promote sustained engagement and ultimately achieve better mental health outcomes.