Expanding the Circle of Care: How Children's Utilization of Therapy May Support the Therapy Utilization of Hispanic Caregivers

Background and Purpose:

Hispanics represented over 50% of U.S. population growth from 2010 to 2022, yet they face disparities in mental health service use. Despite a high prevalence of mental health conditions, Hispanic adults are less likely than White adults to receive treatment due to barriers like lack of insurance, limited awareness, and insufficient culturally competent care. Although parental involvement in child therapy improves outcomes, research on whether children’s therapy attendance affects Hispanic caregivers’ therapy engagement is scarce. This study investigates if having children in therapy increases Hispanic caregivers' therapy participation and how this varies by caregiver nativity. It also explores how having a child in therapy impacts U.S.-born and Immigrant Hispanics differently. The study hypothesizes: (1) U.S.-born Hispanic caregivers will have higher therapy utilization than Immigrant caregivers; (2) caregivers of children in therapy will have increased therapy attendance; and (3) this relationship will persist across nativity, though the effect may vary between U.S. and Immigrant groups.

Methods:

A secondary analysis was conducted using the 2022 and 2023 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of the non-institutionalized U.S. population. The analytic sample included 2,223 Hispanic adults, with data merged from both adult and child datasets to capture relevant variables. Hierarchical linear modeling (HLM) was employed to examine predictors of caregiver therapy attendance in the past 12 months, accounting for individual (Level 1) and child (Level 2) characteristics, as well as cross-level interactions. Key predictors included caregiver and child nativity, gender, age, frequency of depressive and anxiety symptoms, and child therapy attendance. Odds ratios and pseudo-R² statistics were calculated, and model fit was assessed through fit statistics.

Results:

The unconditional model indicated a low baseline probability of therapy utilization among Hispanic adults. In the fixed effects model, aligned with previous literature, U.S.-born caregivers had significantly higher odds of attending therapy than Immigrant caregivers (OR = 0.48, p < .001). The level 2 model showed that caregivers whose children attended therapy were over three times more likely to utilize therapy themselves (OR = 3.60, p < .001), supporting the second hypothesis. The cross-level interaction model revealed that while both U.S.-born and Immigrant caregivers were more likely to attend therapy if their children did, the effect was significantly stronger for U.S.-born caregivers (interaction OR = 0.43, p = 0.049). Model fit improved with each successive model.

Conclusions and Implications:

This study highlights the interconnected nature of child and caregiver mental health service utilization within Hispanic populations. It demonstrates that children's therapy attendance can positively influence caregiver participation in therapy, providing a foundation for designing interventions that focus on responding to the whole family to address longstanding disparities in mental health care access. However, the reduced impact among Immigrant caregivers speaks to persistent barriers (e.g., language, unfamiliarity with systems, and more) that need to be further researched through longitudinal designs. Addressing these disparities is essential not only for improving individual well-being but also for reducing structural disparities in our mental health system.