Role of referrals in mental health service disparities for racial and ethnic minority youth.
OBJECTIVE
To investigate racial/ethnic differences in teachers' and other adults' identification and/or encouragement of parents to seek treatment for psychiatric problems in their children and to evaluate if and whether identification/encouragement is associated with service use.


METHODS
Data on identification/encouragement to seek treatment for externalizing disorders (i.e., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and/or conduct disorder) and internalizing disorders (i.e., major depressive episode/dysthymia and/or separation anxiety disorder) and services used were obtained for 6,112 adolescents (13-17 years of age) in the National Comorbidity Survey Adolescent Supplement. Racial/ethnic differences were examined for Latinos, non-Latino blacks, and non-Latino whites.


RESULTS
There were few racial/ethnic differences in rates of youth identification/encouragement and how identification/encouragement related to service use. Only non-Latino black youth with low severity internalizing disorders were less likely to be identified/encouraged to seek services compared with non-Latino white youth with the same characteristics (odds ratio [OR] = 0.4, 95% confidence interval [CI] = [0.2-0.7]). Identification/encouragement increased the likelihood of seeking services for externalizing and internalizing disorders for all youth. However, compared with their non-Latino white counterparts, non-Latino black youth who met criteria for internalizing disorders appeared less likely to have used any services (OR = 0.4, 95%, CI = 0.2-0.7), after adjusting for identification/encouragement, clinical, and sociodemographic characteristics. Non-Latino black youth with internalizing disorders and without identification/encouragement were less likely to use the specialty care sector than their non-Latino white counterparts.


CONCLUSIONS
In this study of a nationally representative sample of adolescents, almost no ethnic/racial differences in identification/encouragement were found. However, identification/encouragement may increase service use for all youth.
Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA, USA. malegria@charesearch.org
Margarita
M
Alegría
Julia Y
JY
Lin
Jennifer Greif
JG
Green
Nancy A
NA
Sampson
Michael J
MJ
Gruber
Ronald C
RC
Kessler
D000293:Adolescent; D044383:Black People / Q000523:psychology; D002653:Child Behavior Disorders / Q000208:ethnology / Q000523:psychology; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008605:Mental Health Services; D008913:Minority Groups / Q000523:psychology*; D012017:Referral and Consultation; D012944:Social Support; D014481:United States; D044465:White People / Q000523:psychology; D001741:Black or African American