Depression has been increasing rapidly and is prevalent among youth. Inadequate mental health service utilization for youth and relevant racial/ethnic disparities are a growing concern. The current study used a nationally representative database to examine racial/ethnic disparities in youth depression prevalence, mental health services utilization, and psychotropic medication receipt. The sequential examination shows that depressed minority youth (22%-30%) were not only much less likely to use specialty mental health services than depressed Caucasian and multiracial youth (40%-43%, p < .001), they were also much less likely to receive psychotropic medications (22%-30%) than their Caucasian and multiracial counterparts (38%-44%, p = .048 to <.001) when using specialty mental health services. The findings reveal possibly two levels of racial/ethnic disparities at the decision points of accessing specialty mental health services and subsequent treatment methods choice. Implications for mental health policies and practices are also discussed.
Abe-KimJ.TakeuchiD. T.HongS.ZaneN.SueS.SpencerM. S.. . . AlegríaM. (2007). Use of mental health-related services among immigrant and US-born Asian Americans: Results from the National Latino and Asian American Study. American Journal of Public Health, 97, 91-98. doi:10.2105/AJPH.2006.098541
2.
AlegríaM.LinJ.GreenJ. (2012). Role of referrals in mental health service disparities for racial and ethnic minority youth. Journal of the American Academy of Child & Adolescent Psychiatry, 51(7), 1-15. doi:10.1016/j.jaac.2012.05.005.Role
3.
AlegriaM.VallasM.PumariegaA. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19, 759-774. doi:10.1016/j.chc.2010.07.001.Racial
4.
AlexanderG. C.GallagherS. A.MascolaA.MoloneyR. M.StaffordR. S. (2012). Increasing off-label use of antipsychotic medications in the United States, 1995-2008. Pharmacoepidemiology and Drug Safety, 20, 177-184. doi:10.1002/pds.2082.INCREASING
5.
AnglinD. M.AlbertiP. M.LinkB. G.PhelanJ. C. (2008). Racial differences in beliefs about the effectiveness and necessity of mental health treatment. American Journal of Community Psychology, 42, 17-24.
6.
BearL.FinerR.GuoS.LauA. S. (2014). Building the gateway to success: An appraisal of progress in reaching underserved families and reducing racial disparities in school-based mental health. Psychological Services, 11, 388-397. doi:10.1037/a0037969
7.
BellonciC.HuefnerJ. C.GriffithA. K.Vogel-RosenG.SmithG. L.PrestonS. (2013). Concurrent reductions in psychotropic medication, assault, and physical restraint in two residential treatment programs for youth. Children and Youth Services Review, 35, 1773-1779. doi:10.1016/j.childyouth.2013.08.007
BradleyK. L.McGrathP. J.BrannenC. L.BagnellA. L. (2010). Adolescents’ attitudes and opinions about depression treatment. Community Mental Health Journal, 46, 242-251. doi:10.1007/s10597-009-9224-5
10.
BrelandD. J.McCartyC. A.ZhouC.McCauleyE.RockhillC.KatonW.RichardsonL. P. (2014). Determinants of mental health service use among depressed adolescents. General Hospital Psychiatry, 36, 296-301. doi:10.1016/j.genhosppsych.2013.12.003
11.
BrennerS. L.SoutherlandD. G.BurnsB. J.WagnerH. R.FarmerE. M. Z. (2014). Use of psychotropic medications among youth in treatment foster care. Journal of Child and Family Studies, 23, 666-674. doi:10.1007/s10826-013-9882-3
12.
Center for Behavioral Health Statistics and Quality. (2017). 2016 National Survey on Drug Use and Health—Public use file codebook. Rockville, MD: Substance Abuse and Mental Health Services Administration.
13.
Center for Behavioral Health Statistics and Quality. (2018a). 2016 National Survey on Drug Use and Health Methodological Resource Book Section 13: Statistical inference report. Rockville, MD: Substance Abuse and Mental Health Services Administration.
14.
Center for Behavioral Health Statistics and Quality. (2018b). 2017 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
15.
ClementS.SchaumanO.GrahamT.MaggioniF.Evans-LackoS.BezborodovsN.. . . ThornicroftG. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 11-27. doi:10.1017/S0033291714000129
16.
CooperL. A.GonzalesJ. J.GalloJ. J.RostK. M.LisaS.RubensteinL. V.. . . FordD. E. (2003). The acceptability of treatment for depression among African-American, Hispanic, and White primary care patients. Medical Care, 41, 479-489. doi:10.1097/01.MLR.0000053228.58042.E4
17.
Corbie-SmithG.ThomasS. B.St. GeorgeD. M. M. (2002). Distrust, race, and research. Archives of Internal Medicine, 162, 2458-2463. doi:10.1001/archinte.162.21.2458
18.
CummingsJ. R.DrussB. G. (2011). Racial/ethnic differences in mental health service use among adolescents with major depression. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 160-170. doi:10.1021/nl061786n.Core-Shell
19.
dosReisS.YoonY.RubinD. M.RiddleM. A.NollE.RothbardA. (2011). Antipsychotic treatment among youth in foster care. Pediatrics, 128, e1459-e1466. doi:10.1542/peds.2010-2970
20.
EisenbergD.DownsM. F.GolbersteinE.ZivinK. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66, 522-541. doi:10.1177/1077558709335173
21.
FearnN. E.VaughnM. G.NelsonE. J.Salas-WrightC. P.DeLisiM.QianZ. (2016). Trends and correlates of substance use disorders among probationers and parolees in the United States 2002-2014. Drug and Alcohol Dependence, 167, 128-139. doi:10.1016/j.drugalcdep.2016.08.003
22.
FisherS.ReynoldsJ. L.HsuW. W.BarnesJ.TylerK. (2014). Examining multiracial youth in context: Ethnic identity development and mental health outcomes. Journal of Youth and Adolescence, 43, 1688-1699. doi:10.1007/s10964-014-0163-2
23.
GalloK.OlinS. S.YorkN.YorkN.Storfer-IsserA.HorowitzS. M. (2018). Parent burden in accessing outpatient psychiatric services for adolescent depression in a large state system. Psychiatric Services, 68, 411-414. doi:10.1176/appi.ps.201600111.Parent
24.
GarlandA. F.LauA. S.YehM.McCabeK. M.HoughR. L.LandsverkJ. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162, 1336-1343. doi:10.1176/appi.ajp.162.7.1336
25.
GudiñoO. G.LauA. S.YehM.McCabeK. M.HoughR. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by problem type?Journal of Emotional and Behavioral Disorders, 17, 3-17. doi:10.1177/1063426608317710
26.
GuoS.KataokaS. H.BearL.LauA. S. (2014). Differences in school-based referrals for mental health care: Understanding racial/ethnic disparities between Asian American and Latino youth. School Mental Health, 6, 27-39. doi:10.1007/s12310-013-9108-2
27.
GuoS.NguyenH.WeissB.NgoV. K.LauA. S. (2015). Linkages between mental health need and help-seeking behavior among adolescents: Moderating role of ethnicity and cultural values. Journal of Counseling Psychology, 62, 682-693. doi:10.1037/cou0000094
28.
HammermanA.DreiherJ.KlangS. (2008). Antipsychotics and diabetes: An age-related association. Annals of Pharmacotherapy, 42, 1316-1322. Retrieved from http://aop.sagepub.com/content/42/9/1316.short
29.
HarrisonM. E.McKayM. M.BannonW. M. (2004). Inner-city child mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40, 119-131. doi:10.1023/B:COMH.0000022732.80714.8b
30.
Hatcher-KayC.KingC. A. (2003). Depression and suicide. Pediatrics in Review, 24, 363-371. doi:10.1542/PIR.24-11-363
31.
KataokaS. H.ZhangL.WellsK. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548-1555. doi:10.1176/appi.ajp.159.9.1548
32.
KesslerR.AndrewsG.MroczekD. (1998). The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7, 171-185. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/mpr.47/full
33.
KimH. S.ShermanD. K.TaylorS. E. (2008). Culture and social support. American Psychologist, 63, 518-526. doi:10.1037/0003-066X
34.
LeeT. G.WalkerS. C.BishopA. S. (2016). The impact of psychiatric practice guidelines on medication costs and youth aggression in a juvenile justice residential treatment program. Psychiatric Services, 67, 214-220. doi:10.1176/appi.ps.201400544
35.
LeonA. C.OlfsonM.PorteraL.FarberL.SheehanD. V. (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. The International Journal of Psychiatry in Medicine, 27, 93-105. doi:10.2190/T8EM-C8YH-373N-1UWD
36.
LindseyM. A.JoeS.NebbittV. (2010). Family matters: The role of mental health stigma and social support on depressive symptoms and subsequent help seeking among African American boys. Journal of Black Psychology, 36(4), 1-19. doi:10.1177/0095798409355796.Family
MarcusS. C.OlfsonM. M. W. (2010). National trends in the treatment for depression from 1998 to 2007. Archives of General Psychiatry, 67, 1265-1273. doi:10.1001/archgenpsychiatry.2010.151
39.
McHughR. K.WhittonS. W.PeckhamA. D.WelgeJ. A.OttoM. W. (2013). Patient preference for psychological vs. pharmacological treatment of psychiatric disorders: A meta-analytic review. Journal of Clinical Psychiatry, 74, 595-602. doi:10.4088/JCP.12r07757
40.
MerikangasK. R.HeJ.BursteinM.SwansonS. A.AvenevoliS.CuiL.. . . SwendsenJ. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980-989.
41.
MorrisJ.StoneG. (2011). Children and psychotropic medication: A cautionary note. Journal of Marital and Family Therapy, 37, 299-306. doi:10.1111/j.1752-0606.2009.00178.x
42.
OlfsonM.BlancoC.LiuS.-M.WangS.CorrellR. W. B. (2012). National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Archives of General Psychiatry, 69, 1247-1256. doi:10.1001/archgenpsychiatry.2012.647
43.
OlfsonM.DrussB. G.MarcusS. C. (2015). Trends in mental health care among children and adolescents. New England Journal of Medicine, 372, 2029-2038.
44.
OlinS. S.ClarkL. J. (2016). Access to care for youth in a state mental health system: A simulated patient approach. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 392-399. doi:10.1016/j.jaac.2016.02.014
PickeringR. P.KaplanK. (2006). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders on alcohol and related conditions. Archives of General Psychiatry, 61, 807-816.
47.
RadovicA.ReynoldsK.McCauleyH. L.SucatoG. S.SteinB. D.MillerE. (2015). Parents’ role in adolescent depression care: Primary care provider perspectives. The Journal of Pediatrics, 167, 911-918. doi:10.1016/j.jpeds.2015.05.049
RichardsonL. A. (2001). Seeking and obtaining mental health services: What do parents expect?Archives of Psychiatric Nursing, 15, 223-231. doi:10.1053/apnu.2001.27019
50.
SantiagoC. D.KaltmanS.MirandaJ. (2013). Poverty and mental health: How do low-income adults and children fare in psychotherapy?Journal of Clinical Psychology, 69, 115-126. doi:10.1002/jclp.21951
51.
SchnittkerJ.FreeseJ.PowellB. (2000). Black-White differences in beliefs about the cause and appropriate treatment of mental illness. Social Forces, 78, 1101-1130. doi:10.3868/s050-004-015-0003-8
52.
ShermanL. J.AliM. M. (2017). Mothers’ mental health treatment associated with greater adolescent mental health service use for depression. Journal of Child and Family Studies, 26, 2762-2771. doi:10.1007/s10826-017-0781-x
53.
SnowdenL. R. (2003). Bias in mental health assessment and intervention: Theory and evidence. American Journal of Public Health, 93, 239-243. doi:10.2105/AJPH.93.2.239
54.
SteinmanK. J.ShobenA. B.DembeA. E.KelleherK. J. (2015). How long do adolescents wait for psychiatry appointments?Community Mental Health Journal, 51, 782-789. doi:10.1007/s10597-015-9897-x
55.
StrawnJ. R.DobsonE. T.GilesL. L. (2017). Primary pediatric care psychopharmacology: Focus on medications for ADHD, depression, and anxiety. Current Problems in Pediatric and Adolescent Health Care, 47, 3-14. doi:10.1016/J.CPPEDS.2016.11.008
Substance Abuse and Mental Health Services Administration. (2017). 2016 National Survey on Drug Use and Health—Public use file codebook. Rockville, MD: Author.
58.
SueS.ChengJ. K. Y.SaadC. S.ChuJ. P. (2012). Asian American mental health: A call to action. American Psychologist, 67, 532-544. doi:10.1037/a0028900
59.
TelzerE. H.FuligniA. J. (2009). Daily family assistance and the psychological well-being of adolescents from Latin American, Asian, and European backgrounds. Developmental Psychology, 45, 1177-1189. doi:10.1037/a0014728
60.
ThaparA.CollishawS.PineD. S.ThaparA. K. (2012). Depression in adolescence. The Lancet, 379, 1056-1067. doi:10.1016/S0140-6736(11)60871-4
61.
VaughnM. G.NelsonE. J.Salas-WrightC. P.DeLisiM.QianZ. (2016). Handgun carrying among White youth increasing in the United States: New evidence from the National Survey on Drug Use and Health 2002-2013. Preventive Medicine, 88, 127-133. doi:10.1016/j.ypmed.2016.03.024
62.
VaughnM. G.Salas-WrightC. P.DeLisiM.MaynardB. R. (2014). Violence and externalizing behavior among youth in the United States: Is there a severe 5%?Youth Violence and Juvenile Justice, 12, 3-21. doi:10.1177/1541204013478973
63.
VriesY.JongeP.KalverdijkL.BosJ. (2016). Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: Choice of antidepressant and dose. European Child & Adolescent Psychiatry, 25, 1161-1170. Retrieved from http://link.springer.com/article/10.1007/s00787-016-0836-3
64.
WatanabeN.HunotV.OmoriI. M.ChurchillR.FurukawaT. A. (2007). Psychotherapy for depression among children and adolescents: A systematic review. Acta Psychiatrica Scandinavica, 116, 84-95. doi:10.1111/j.1600-0447.2007.01018.x
65.
WirbackT.MöllerJ.LarssonJ. O.EngströmK. (2018). Social differences in diagnosed depression among adolescents in a Swedish population based cohort. BMC Psychiatry, 18, 15-17. doi:10.1186/s12888-018-1765-0
66.
Zahn-WaxlerC.ShirtcliffE. A.MarceauK. (2008). Disorders of childhood and adolescence: Gender and psychopathology. Annual Review of Clinical Psychology, 4, 275-303. doi:10.1146/annurev.clinpsy.3.022806.091358
67.
ZhangS.SmithD. C.TabbK. M. (2018). Adolescent depression and the use of services and psychotropic medications in relation to family structure and race/ethnicity. Children and Youth Services Review, 94, 636-643. doi:10.1016/J.CHILDYOUTH.2018.09.004
68.
ZitoJ. M.SaferD. J.ZuckermanI. H.GardnerJ. F.SoekenK. (2005). Effect of Medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services, 56, 157-163. doi:10.1176/appi.ps.56.2.157
