title: Socioeconomic position predicts specialty mental health service use independent of clinical severity: the TRAILS study.
abstract: OBJECTIVE
  To investigate associations between different indices of family socioeconomic position (SEP) and the use of specialty mental health services (SMHS) and whether the associations exist after adjusting for severity of mental problems.
  
  
  METHODS
  Using data from a large longitudinal study of adolescents (N = 2,149; mean age = 13.6 years [SD = 0.53, range = 12 to 15 years]; 51% girls), we assessed the relations of family SEP indices with SMHS use while accounting for severity of mental problems in logistic regression models. Multiple informants (parent, self, and teachers) assessed severity of mental health problems using the Achenbach scales. A parent questionnaire was used to assess family SEP (parents' education, parents' occupation, and family income) and SMHS use. Baseline response rate was 76%, and 96.4% of responders were reassessed at a 2.5-year follow-up visit. Baseline assessments ran from March 2001 through July 2002 and follow-up from September 2003 to December 2004.
  
  
  RESULTS
  Overall, 6.7% of the total sample and 42.9% of those with mental problems accessed SMHS. Univariable analyses yielded no significant associations between SMHS and all the indices of SEP. Adjustment for the severity of mental problems resulted in substantial and statistically significant associations of indices of SEP with SMHS use. Adolescents were particularly more likely to use SMHS with increasing levels of maternal education. Compared to mothers with elementary education, those with university education were three times more likely to consult SMHS independent of severity of their offspring's mental health problems (odds ratio [OR] = 3.18, confidence interval [CI] = 1.22, 8.30). For the aggregate measure of SEP, high SEP was associated with increased use of SMHS compared with low SEP (OR = 1.63, CI = 1.04, 2.55).
  
  
  CONCLUSIONS
  Higher levels of maternal education and overall SEP predict more SMHS use when the severity of mental problems was accounted for. Without correcting for the severity of mental problems, the true association between SEP and SMHS use is obscured in early adolescents.
authors.affiliation: Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. kpamone@gmail.com
authors.forename: Kennedy
authors.initials: K
authors.lastname: Amone-P'Olak
authors.forename: Johan
authors.initials: J
authors.lastname: Ormel
authors.forename: Albertine J
authors.initials: AJ
authors.lastname: Oldehinkel
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
authors.forename: Frank C
authors.initials: FC
authors.lastname: Verhulst
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D009426:Netherlands; D012044:Regression Analysis; D012959:Socioeconomic Factors