title: Correlates of unmet need for mental health services by children and adolescents.
abstract: BACKGROUND
  Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents.
  
  
  METHODS
  Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months.
  
  
  RESULTS
  Of the total sample, 17.1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parent's will. No youth-reported access barriers were significantly associated with unmet need.
  
  
  CONCLUSIONS
  The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.
authors.affiliation: Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Flisher
authors.forename: R A
authors.initials: RA
authors.lastname: Kramer
authors.forename: R C
authors.initials: RC
authors.lastname: Grosser
authors.forename: M
authors.initials: M
authors.lastname: Alegria
authors.forename: H R
authors.initials: HR
authors.lastname: Bird
authors.forename: K H
authors.initials: KH
authors.lastname: Bourdon
authors.forename: S H
authors.initials: SH
authors.lastname: Goodman
authors.forename: S
authors.initials: S
authors.lastname: Greenwald
authors.forename: S M
authors.initials: SM
authors.lastname: Horwitz
authors.forename: R E
authors.initials: RE
authors.lastname: Moore
authors.forename: W E
authors.initials: WE
authors.lastname: Narrow
authors.forename: C W
authors.initials: CW
authors.lastname: Hoven
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D016241:Child of Impaired Parents / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005192:Family Health; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D016017:Odds Ratio; D012494:Sampling Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology