title: Contextual socioeconomic status and mental health counseling use among US adolescents with depression.
abstract: Most adolescents with depressive disorders do not receive any mental health services, even though effective treatments exist. Although research has examined numerous individual-level factors associated with mental health service use among depressed adolescents, less is known about the role of contextual factors. This study examines the relationship between contextual-level socioeconomic status (SES) and clinic-based mental health counseling use among US adolescents with high depressive symptoms in urban and suburban areas. Data from the first two waves of the National Longitudinal Study of Adolescent Health (N = 1,133; 59 % female) were analyzed using multilevel logistic models in which adolescents were nested within counties. After controlling for individual-level predisposing, enabling, and need characteristics, as well as county racial/ethnic composition, county SES was positively associated with clinic-based counseling use among depressed youth. A one standard deviation increase in the county affluence index was associated with 43 % greater odds of receiving any clinical counseling services. Furthermore, the positive relationship between county affluence and clinical counseling use was no longer significant after controlling for the county supply of mental health specialist physicians. The results indicate that county residential context is a key correlate of mental health service use among depressed adolescents, such that those who live in lower SES counties with fewer mental health specialists are less likely to receive treatment.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Suite 650, Atlanta, GA, 30322, USA, jrcummi@emory.edu.
authors.forename: Janet R
authors.initials: JR
authors.lastname: Cummings
mesh_terms: D000293:Adolescent; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003376:Counseling / Q000706:statistics & numerical data*; D003863:Depression / Q000208:ethnology / Q000628:therapy*; D003866:Depressive Disorder / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D063588:National Longitudinal Study of Adolescent Health; D012923:Social Class; D014481:United States; D014504:Urban Health