title: Mental health service use by young people: the role of caregiver characteristics.
abstract: OBJECTIVE
  Many children and adolescents experiencing mental health problems do not receive appropriate care. Strategies to encourage appropriate access to services might be improved by a more detailed understanding of service use determinants within this group. In view of caregivers' key role in young people's pathways to care, this study aimed to advance understanding of caregiver-related characteristics that influence service use among young people.
  
  
  METHODS
  We interviewed 407 primary caregivers of young people aged 9-18 years, recruited from a Greater London (United Kingdom) community sample. Caregivers reported on young people's service use in health care sector and/or education settings, and caregivers' intended stigmatising behaviours, help-seeking attitudes, and personal service use. Logistic regression analyses examined the relationship between these caregiver characteristics and young people's service use, controlling for young people's clinical and socio-demographic factors.
  
  
  RESULTS
  Caregivers' intended stigmatising behaviours in particular exerted a strong influence on young people's service use within each service setting. The impact of this characteristic interacted with caregivers' service use in influencing young people's service use across health care and education settings and health care settings specifically. For young people's service use within education settings, caregivers' intended stigmatising behaviours score had a main effect.
  
  
  CONCLUSIONS
  This study highlights the key role caregivers' attitudes and experiences hold in young people's service use. The findings indicate that strategies aiming to bridge the gap between young people's service needs and utilisation might be improved by targeting stigma amongst caregivers.
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors: Petra C
authors: PC
authors: Gronholm
authors: Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
authors: Tamsin
authors: T
authors: Ford
authors: Department of Forensic and Neurodevelopmental Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors: Ruth E
authors: RE
authors: Roberts
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors: Graham
authors: G
authors: Thornicroft
authors: Department of Forensic and Neurodevelopmental Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; School of Psychiatry, University of New South Wales, Sydney, Australia; Schizophrenia Research Institute, Sydney, Australia.
authors: Kristin R
authors: KR
authors: Laurens
authors: Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors: Sara
authors: S
authors: Evans-Lacko
mesh_terms: D000293:Adolescent; D017028:Caregivers; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008605:Mental Health Services; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D062486:Public Health Surveillance; D012959:Socioeconomic Factors