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Try out PMC Labs and tell us what you think. Learn More. Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth. School-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations. All students were from the same high school and all had access to a school-based mental health clinic.
Across all ethnicities, the prevalence of depressive symptoms was highest among females. Depressed White students were more likely than depressed minority youth to report having received a prior diagnosis of depression and to have been treated for depression. Thus, ethnic disparities in obtaining needed mental health care may persist even in settings where access to equivalent care is readily available. Psychological problems abound among adolescents, with as many as one in five youth suffering from mental illness, and many more living with subthreshold psychological distress.
Some of this ethnic disparity in receiving needed care can be explained by the fact that adolescents of color are disproportionately lower-income and are less likely to be insured, than their White peers. In order to increase needed service use among hard-to-reach populations, we must move beyond financial factors and address ethnic differences in the stigma associated with and access to mental health care, as well as the notion that our health care system is tailored to non-minorities.
By providing access to all students, school-based health centers are one way to increase health care utilization, and may be particularly important for accessing hard-to-reach populations such as minority and low-income youth. The present study extends existing research on the receipt of needed mental health care by examining an ethnically diverse adolescent sample with access to a school-based mental health clinic.
The fact that the clinic is available to all students in the school will help us determine whether providing equivalent access to care decreases the difference in unmet need often identified between adolescents of color and their White counterparts. Here, we define unmet need as existing in students who score in the moderate or high range on a depression screening, but who have never received treatment for depression, disclosed symptoms of depression, or been diagnosed with depression.
Despite access to the same level of mental health services, we hypothesized that minority adolescents would be less likely to utilize needed care than their White counterparts. Participating students were similar in gender and ethnic distribution to the total student body. Passive parental consent was obtained. Specifically, parents were informed of the study and options to opt their child out via automated messages and mailed announcements.
All materials, including screening instrument, psychoeducational materials, and community referral information, were available in English and Spanish. Five parents chose to opt their children out of the study. All students present on the day of administration and not excluded by parent request were eligible to participate. Students could elect not to participate.
Information is not available on the exact of students absent on assessment days versus those who did not assent, but very few students elected to not participate. Participants ranged in age from 13 to 19 years, with an average age of Data collection occurred over a two-week period in Spring Participants completed a brief self-report questionnaire during their normally scheduled class time. Prior to completing the surveys, students were given a brief curricula-based overview of depression and mental health e.
The school-based mental health system available at the high school campus uses a multidisciplinary teamwork approach to providing care involving psychiatrists, pediatricians, developmental pediatricians, nurse practicioners, psychologists, social workers, and child and parent community advocates.
Students are generally referred by their parents through consultation with teachers or administrators in the school system, and from other local community-based care providers. Mental health services are provided on a daily basis, and generally involve screening and continued therapy. The program had been in operation under its current structure for a year and a half prior to data collection. The CES-D is a item self-administered scale that assesses the frequency of depressive symptoms during the past week using a four-point rating scale anchored by 0 experienced rarely or none of the time and 3 experienced most or all of the time.
A CES-D score of 16 or above is the standard cut-off point for identifying individuals at high risk of depression. The CES-D has demonstrated strong internal consistency, adequate test-retest reliability, and is a valid measure of depression for high school students. As shown in Table 2 , for the sample and across all ethnicities, the prevalence of depressive symptoms was highest among females t 5 8. In addition, we did not find a ificant interaction between gender and ethnicity.
No differences were found for treatment for depression. As demonstrated in Table 3 , and after considering gender, there were substantial differences by ethnicity. Among female students at risk for depression, White females reported a prior diagnosis 4. Finally, ificant ethnic differences were also found in regards to having disclosed depressive symptoms to an adult within the past year.
Approximately a third of the male and half of the female students screened positive for depression or subthreshold depression. However, unlike the YRBS that found higher rates of depression among Hispanic adolescents, we found ificantly higher rates of depression among White students. Overall, adolescent females with depressive symptoms were more likely than their male counterparts to report a prior diagnosis of depression and to have disclosed depressive symptoms to adults.
With respect to ethnicity, White students with symptoms of depression were more than twice as likely as their Hispanic counterparts to have received a prior diagnosis of depression. Among female students with depressive symptoms, White females were over four times more likely to report a prior diagnosis of depression than Black females with depressive symptoms, and nearly three times more likely than Hispanic students with depressive symptoms.
A similar pattern was observed for treatment for depression within this same group of female students. Thus, having access to a school-based mental health clinic did not appear to alleviate ethnic disparity on indicators of accessing and using needed care. Coupled with existing research on income and insurance status, 5 , 6 these findings suggest that differences in socioeconomic status and accessibility do not fully explain ethnic disparities in mental health care utilization. Additional research should investigate whether minority youth and their parents who must consent to treatment have different health-related beliefs than their White counterparts.
For example, it is possible that the shame and stigma associated with receiving psychological treatment is a stronger impediment to receiving needed care for minority youth than for White youth. However, research is mixed on the relationship between ethnicity and stigma of mental health treatment among adults.
Alternatively, it may be that minority youth are more likely to be referred to and seek help from less medically oriented resources such as church, family members, or community mentors. Additional research is needed to determine whether ethnic disparities in receiving needed mental health care may be partially explained by African American and Hispanic adolescents seeking non-clinical care for their psychological needs.
Future research should control for income, insurance status, and psychological treatment. The absence of these controls is a major limitation of the present study. Ensuring that adolescents have access to and utilize needed mental health care has important and long-lasting implications. At the very least, adolescents who receive appropriate care may be more inclined to use the health care system as adults.
Further, when youth access services, it affords health care providers an opportunity to identify and modify risky behaviors and promote healthy living. School-based mental health centers address many of the ificant barriers that limit access to mental health services by providing them in the setting where children spend the majority of their time, their school. It is important to note that the school-based mental health system discussed in this study has been in operation for less than two years. Link and Phelen recently suggested that individuals with more resources, knowledge, and support initially benefit the most from novel approaches to improving health.
However, they further state that innovative approaches to improving health ultimately benefit everyone. In fact, Black, White, and Hispanic students are represented fairly equally by patient population of this clinic. Study limitations include using self-report data and a lack of information on individual socioeconomic status variables and use of other health care services. The explanatory power of our data would have been substantially stronger had we assessed this information. In addition, data were collected from a single high school in Southeast Texas, so these findings may not generalize to other communities.
Future research would benefit from including a control school without a mental health clinic. Despite these limitations, the findings make it clear that we must do a better job of reaching those in need of mental health care, with a particular focus on adolescent boys and minority youth. Specifically, even with access to the same level of care that is not affected by income or insurance status, adolescent youth of color with psychological problems may not be having their needs met.
This suggests that efforts must be made to educate the broader community on the importance of recognizing mental health symptoms and receiving needed health care. This work would not have been possible without the permission and assistance of the Galveston Independent School District. John F. Jeff R. National Center for Biotechnology Information , U. J Health Care Poor Underserved. Author manuscript; available in PMC Feb 1. Author information Copyright and information Disclaimer. Copyright notice.
See other articles in PMC that cite the published article. Abstract Psychological problems are overlooked and undertreated in adolescents, especially in low-income and ethnically-diverse youth. Keywords: School-based mental health care, adolescents, ethnicity, gender, utilization. School-based mental health services The school-based mental health system available at the high school campus uses a multidisciplinary teamwork approach to providing care involving psychiatrists, pediatricians, developmental pediatricians, nurse practicioners, psychologists, social workers, and child and parent community advocates.
Open in a separate window. Discussion Approximately a third of the male and half of the female students screened positive for depression or subthreshold depression. Acknowledgments Dr. Contributor Information John F. Notes 1. Prevalence and development of psychiatric disorders in childhood and adolescence.
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