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APHA Scientific Session and Event Listing

Janet R. Cummings, BA¹, Richard G. Wight, PhD², and Carol S. Aneshensel, PhD². (1) Health Services, UCLA, P.O. Box 951772, Los Angeles, CA 90095-1772, 310-267-2490, jrc12@ucla.edu, (2) Community Health Sciences, UCLA, P.O. Box 951772, Los Angeles, CA 90095-1772

The majority of adolescents in need of mental health care do not receive services. In spite of the large body of literature examining individual-level factors associated with adolescent mental health use, there is little information about the role of contextual-level factors. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we apply the Andersen model of health services utilization to examine the relationship between community-level socioeconomic status and mental health service use among adolescents, controlling for predisposing, enabling, and need-related factors at the individual level. Specifically, we estimate hierarchical logistic models to examine the relationship between community-level income and adolescents' self-reported use of counseling services, operationalized as: 1) any counseling services; 2) counseling services in a clinical setting; 3) counseling services in a school setting; and 4) counseling services in other setting(s). Controlling for individual-level factors, community-level income is positively associated with the use of “any” counseling services (ß=0.59, p=0.001) and accounts for 24% of the contextual-level variation in the use of any counseling services. Community-level income is also positively associated with the use of counseling services in a clinical setting (ß=0.71, p<0.001) and accounts for 32% of the contextual-level variation in the use of clinical counseling services. Community-level income is not significantly associated with the use of school-based services or “other” counseling services. Importantly, these findings highlight how efforts to influence adolescents' mental health service use may be of limited success if the impact of the larger social context is not addressed.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Recognize the importance of including contextual-level factors, in addition to individual-level factors, when modeling adolescents’ use of mental health services.
• Describe the relative association between community-level income and adolescents’ use of mental health services in multiple settings (clinic, school, and other).

Keywords: Mental Health Services, Access to Care

Presenting author's disclosure statement:

Any relevant financial relationships? No