title: The mental health care gap among children and adolescents: data from an epidemiological survey from four Brazilian regions.
abstract: BACKGROUND
  Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy.
  
  
  OBJECTIVE
  To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU.
  
  
  METHODS
  Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721). Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1) children/adolescent characteristics [(1.1) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)-psychiatric disorders; (1.2) Ten Questions Screen-neurodevelopment problems; (1.3) two subtests of WISC-III-estimated IQ; (1.4) Academic Performance Test-school performance)], (2) factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression), (3) family (Brazilian Research-Companies-Association's Questionnaire-SES).
  
  
  RESULTS
  Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions) regardless of the presence of any psychiatric disorders/neurodevelopmental problems.
  
  
  CONCLUSIONS
  Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental health specialist in the previous 12 months. Structural/psychosocial/demographic factors were associated with uneven access to service for certain groups of children/adolescents. These results call attention to the urgent need to implement programs to help reduce this large unmet mental health need; inequalities must be considered by policy makers when planning strategies to address barriers for care.
authors.affiliation: Programa de Pós-Graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, São Paulo, Brasil ; Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
authors.forename: Cristiane S
authors.initials: CS
authors.lastname: Paula
authors.affiliation: Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
authors.forename: Isabel A S
authors.initials: IA
authors.lastname: Bordin
authors.affiliation: Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
authors.forename: Jair Jesus
authors.initials: JJ
authors.lastname: Mari
authors.affiliation: Departamento de Matemática de Estatística. Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Luciane
authors.initials: L
authors.lastname: Velasque
authors.affiliation: Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Rohde
authors.affiliation: Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Escola Nacional de Saúde Pública-FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Evandro S F
authors.initials: ES
authors.lastname: Coutinho
mesh_terms: D000293:Adolescent; D001938:Brazil; D002648:Child; D002660:Child Guidance / Q000458:organization & administration; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000235:genetics; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012923:Social Class; D011795:Surveys and Questionnaires