Gender disparities in mental health service use of Puerto Rican children and adolescents.
BACKGROUND
Differences in service utilization indicating that boys use more mental health services than girls were analyzed to see if they could be explained by known correlates of service use. These correlates were arranged into individual (severe emotional disturbance, level of impairment and externalizing disorders), family (parental education, psychopathology and parental concern) and school factors (difficulties with school work). The objectives were to understand and identify the factors accounting for gender differences in mental health service utilization in order to develop alternatives to promote equity in service delivery.


METHODS
A representative sample of 1,896 children 4 to 17 years of age and their primary caretakers were interviewed for this study. Reports of service use were obtained using the Service Assessment for Children and Adolescents. Logistic regression was used to assess the relationship between gender and service use, adjusting for known correlates.


RESULTS
Our results showed that, except for impairment, other individual, family and school factors did not explain gender differences in service utilization. Males with impairment were 2.87 times more likely to receive services than impaired females (p <or= .01), and this result continued to hold true for impaired undiagnosed boys compared to impaired diagnoses-free girls (p <or= .001).


CONCLUSIONS
Our findings showed a service disparity between impaired boys and girls who did not meet criteria for a DSM IV diagnosis, but no observed differences in service use between boys and girls who met criteria for severe emotional disturbance (SED). Continued investigations are necessary to analyze, assess and understand the different circumstances that bring boys and girls into treatment, followed by the development of appropriate intervention programs at the school and community levels.
Cabiya
José J
JJ
Carlos Albizu University, San Juan, Puerto Rico.
Canino
Glorisa
G
Chavez
Ligra
L
Ramirez
Rafael
R
Alegría
Margenta
M
Shrout
Patrick
P
Hohman
Ann
A
Bravo
Milagros
M
Bauermeister
José J
JJ
Maritínez-Taboas
Alfonso
A
D000293:Adolescent; D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D000367:Age Factors; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D002675:Child, Preschool; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007389:Internal-External Control; D007406:Interview, Psychological; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D011647:Puerto Rico; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D014600:Utilization Review / Q000706:statistics & numerical data