title: Predicting service use for mental health problems among young children.
abstract: OBJECTIVE
  To identify sociodemographic, child, parent, and day care provider factors at age 4 that predict Norwegian children's service use for mental health problems at age 7.
  
  
  METHODS
  Two birth cohorts of 4-year-old children and their parents living in the city of Trondheim, Norway, were invited (82% consented). We successfully interviewed 995 parents among 1250 drawn to participate using the Preschool Age Psychiatric Assessment to set diagnoses and record parental burden and service use. Information concerning sociodemographics, child impairment, parental social support, and child need for mental health services according to parents, day care teacher, and health nurse were obtained.
  
  
  RESULTS
  Rate of service use among those with a behavioral or emotional disorder was 10.7% at age 4 and 25.2% at age 7. Behavioral disorders (odds ratio [OR] 2.6, confidence interval [CI] 1.3-5.3), but not emotional disorders, predicted service use. When adjusted for incapacity (OR 1.3, CI 1.2-1.6), disorders were no longer predictive. Incapacity, in turn, was not predictive once parental burden (OR 1.1, CI 1.0-1.1) and parents' (OR 2.7, CI 1.0-7.9) and day care teachers' (OR 2.1, CI 1.4-3.2) judgment of child need of help were included. Lower socioeconomic status predicted more service use over and beyond these factors (OR 3.0, CI 1.5-6.1).
  
  
  CONCLUSIONS
  Behavioral disorders may instigate service use if they result in impairment, and such impairment may operate via increased parental burden and parent and caregiver problem recognition. Service use may be increased through effective screening programs and efforts to increase day care teachers' recognition of emotional problems.
authors.affiliation: Departments of Psychology andNTNU Social Science, Trondheim, Norway;Department of Child and Adolescent Psychiatry, St Olav's Hospital, Trondheim, Norway; lars.wichstrom@svt.ntnu.no.
authors.forename: Lars
authors.initials: L
authors.lastname: Wichstrøm
authors.affiliation: NTNU Social Science, Trondheim, Norway;Department of Psychology, University of California, Davis, Davis, California; andDepartment of Special Education, King Abdulaziz University, Jeddah, Saudi Arabia;
authors.forename: Jay
authors.initials: J
authors.lastname: Belsky
authors.affiliation: Department of Child and Adolescent Psychiatry, St Olav's Hospital, Trondheim, Norway;Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
authors.forename: Thomas
authors.initials: T
authors.lastname: Jozefiak
authors.affiliation: Department of Child Psychiatry, Turku University, Turku, Finland.
authors.forename: André
authors.initials: A
authors.lastname: Sourander
authors.affiliation: Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;
authors.forename: Turid Suzanne
authors.initials: TS
authors.lastname: Berg-Nielsen
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009664:Norway; D016487:Parenting / Q000523:psychology; D010552:Personality Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: impact; impairment; longitudinal; preschool; service use