Examining Factors Related to Child and Adolescent Mental Health Treatment and Access to Care

Background and Purpose: The COVID-19 pandemic has exposed and exacerbated the human rights injustices already present in society, including addressing the mental health needs of children and adolescents, particularly those from marginalized populations (McMorrow, et al., 2020). In 2019, 21% of children ages 3-17 had a diagnosis of anxiety, depression, or ADD/ADHD (Panchal, et al., 2022), but less than half received any treatment (Whitney & Peterson, 2019). Variations in diagnosis and access to treatment may be related to a child’s identity and socioeconomic status (Hodgkinson, et al., 2017). The purpose of this research was to better understand whether treatment outcomes in forms of counseling, prescribed medications, or both, differed across a child’s demographic characteristics, household income, or mental health diagnosis.

Methods: We analyzed data from the nationally representative Medical Expenditure Panel Survey (MEPS), which asks participants about health and mental health conditions, health care access, and household information. Using common identifiers, we merged data from 2018 across the Prescriptions, Medical Conditions, and Household files (N=7,125). We then selected variables of interest including the child’s age, gender, race/ethnicity, family household income, and mental health diagnosis. The three treatment outcomes included participation in counseling, prescribed medications, or both. Mental health diagnoses were identified using the International Classification of Diseases (ICD), 10th revision. All psychotropic medications were included for data analysis and were manually reviewed for accuracy. Data analyses included descriptive statistics and logistic regression.

Results: Children were significantly more likely to participate in counseling if they had a mental health diagnosis (OR=8.8, CI=1.46-6.36, p<0.05) and if their household income fell below the federal poverty line (FPL) (OR=6.6, CI=1.95-14.70, p<0.05). Children were significantly more likely to be prescribed medication if they had a mental health diagnosis (OR=1082.7, CI=111.68-202.97, p<0.05), their household income was below the FPL (OR=4.6, CI=0.93-1.94, p<0.05), were between the ages of 15-17 (OR=7.77, CI=1.38-2.79, p<0.05), and significantly less likely if they identified as Hispanic (OR=7.08, CI=0.47-0.89, p<0.05). Finally, children were significantly more likely to receive both if they had a mental health diagnosis (OR=82.14, CI=10.44-38.08, p<0.05), if their household income was at or below 200% of the FPL (OR=4.5, CI=0.42-1.28, p<0.05), and were between the ages of 10-14 (OR=4.3, CI=1.38-3.70, p<0.05).

Implications: Mental health diagnosis, household income, and age were the three most significant factors that predicted the type and participation in treatment. Understanding access to types of mental health care is an important social justice issue that social workers are positioned to address through culturally-responsive practice, policy advocacy, and future research.