title: Unmet Need for Specialty Mental Health Services Among Children Across Europe.
abstract: OBJECTIVE
  The aim of this study was to examine the determinants of use of mental health services for children across Europe, with a specific focus on differences in the availability of mental health resources.
  
  
  METHODS
  Data were drawn from the School Children Mental Health in Europe Project. Parent- and teacher-reported child mental health status was based on the Strengths and Difficulties Questionnaire. Sociodemographic characteristics of parents and children, as well as academic performance and use of mental health services in the previous 12 months, were collected. Countries were categorized as having high versus low mental health resources. The sample comprised 4,894 schoolchildren in seven countries.
  
  
  RESULTS
  Across Europe, only 25.6% of children with a mental disorder had received mental health services in the previous 12 months, including 31.5% in high-resources countries and 18.9% in low-resources countries (p=.001) (N=4,867). The presence of any mental disorder, maternal psychological distress, gender, living in a single-parent home, and low academic performance were determinants of service use. The effect of resources group on the likelihood of receiving services remained significant when the analyses controlled for all predictors (odds ratio=1.41, p<.01). Determinants differed between groups-maternal psychological distress was associated with service use in high-resources countries, and gender was associated with service use in low-resources countries.
  
  
  CONCLUSIONS
  The findings point to a substantial portion of unmet need across Europe and to major differences in access to care in low- versus high-resources countries. Efforts are needed to address unmet need among children with mental disorders, especially in low-resources countries.
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Viviane
authors.initials: V
authors.lastname: Kovess-Masfety
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Van Engelen
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Stone
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Roy
authors.initials: R
authors.lastname: Otten
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Mauro Giovanni
authors.initials: MG
authors.lastname: Carta
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Adina
authors.initials: A
authors.lastname: Bitfoi
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Ceren
authors.initials: C
authors.lastname: Koc
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Goelitz
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Sigita
authors.initials: S
authors.lastname: Lesinskiene
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Zlatka
authors.initials: Z
authors.lastname: Mihova
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermanian
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Ondine
authors.initials: O
authors.lastname: Pez
authors.affiliation: Dr. Kovess-Masfety is with the Department of Psychology, Paris Descartes University, and with the EHESP French School of Public Health, where Dr. Fermanian and Dr. Pez are affiliated, both in Paris. Ms. Van Engelen, Dr. Stone, and Dr. Otten are with Radboud University, Nijmegen, Gelderland, the Netherlands. Dr. Carta is with the Department of Public Health, Center of Liaison Psychiatry, Cagliari University, Cagliari, Italy. Dr. Bitfoi is with the Romanian League for Mental Health, Bucharest, Romania. Ms. Koc is with the Yeniden Health and Education Society, Istanbul, Turkey. Dr. Goelitz is with Friedrich-Alexander University Erlangen-Nurnberg, Germany. Dr. Lesinskiene is with the School of Medicine, University of Vilnius, Lithuania. Dr. Mihova is with the Department of Psychology, New Bulgaria University, Sofia, Bulgaria. Dr. Husky is with the Department of Psychology, University of Bordeaux, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Husky
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data*; D012574:Schools / Q000706:statistics & numerical data
keywords: Child psychiatry/general; Mental health systems/hospitals; access to care; determinants; unmet need