Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data

Abstract

Background To inform the provision and organization of care, and to improve equitable access to mental health services for children and youth, we must first characterize the children and youth being served, taking into consideration factors related to mental health need. Our objective was to use a population-based survey linked with health administrative data to estimate mental health related contacts and determine socio-demographic correlates, after adjusting for factors related to mental health need. Methods Data from the 2014 Ontario Child Health Study (OCHS) were linked at the individual level to health administrative databases from Ontario’s Ministry of Health and Long-Term Care (MOHLTC). Mental health related service contacts were identified in the 6-months prior to the OCHS survey date. Service contacts with physicians were obtained from health administrative data, and non-physician service contacts from survey data (parent-report). Results 21.7% of Ontarian children (4–11 years) and youth (12–17 years) had at least one mental health related contact in the 6-months prior to their OCHS survey date (18.8% non-physician, 8.0% physician, 5.2% both). Children and youth contacting both physician and non-physician services (ref. contact with physician or non-physician services alone) had higher mean symptom ratings of mental disorders across all classes of disorder. After adjusting for total symptom ratings, children and youth with immigrant parent(s) (ref. non-immigrant) (Prevalence Ratio: 0.65, 95% CI 0.55, 0.75) were less likely to have any mental health related service contact. Conclusions Results indicate that children and youth with the highest mental health symptom ratings are more likely to have contact with multiple providers across sectors. As such, the coordination of care across and within sectors are critical components of mental health related services for children and youth. Our results indicate that the greatest disparities in mental health related service contacts may exist for children and youth with immigrant parent(s) and that targeted outreach efforts are required to reduce barriers to care and improve equitable access to mental health related services for children and youth in Ontario.

Correlates of child mental health and substance use related emergency department visits in Ontario: A linked population survey and administrative health data study

“…Our finding that older age is associated with ED visits for mental health or substance use concerns is consistent with previous research [ 5 , 25 ] and descriptive statistics for this study demonstrating that 37 of the 54 (68.5%) ED visits in the 12-month follow-up period occurred among youths aged 14–17 years. A separate study from the 2014 OCHS demonstrates that older children (age 12–17) are more likely to have contact with physician (e.g., primary care, hospitals, and EDs) vs. non-physician (e.g., community- or school-based) services for mental health concerns [ 25 ], and our findings suggest this may be partly attributable to more ED visits. Household income below the LIM was also an important factor that may increase the risk of mental health and substance use related ED visits among 14–17 year olds.…”

“…Parental immigrant status was associated with mental health and substance use related ED visits for all children regardless of age. Inequities in access to mental health services for children with immigrant parents are well-documented [ 25 , 26 ], and our findings are consistent with evidence demonstrating that EDs often serve as a first point of contact with mental health care among this population [ 27 ]. Together with previous evidence, our findings highlight an urgent need to address inequities in access to mental health care across service sectors and settings.…”

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

“…Here, only two-parent households showed significant increases in MHS utilization. This finding is similar to prior studies which demonstrate worse mental health outcomes in children living in nontwo-parent homes compared to the two-parent family structure, both pre-COVID-19 and during COVID-19 [ 13 ]. Indeed, we found a downtrend in MHS utilization for adolescents living within a no-parent household during the pandemic.…”

“…U.S. national survey data report children living in single-parent households have a greater likelihood of having unmet healthcare needs [ 11 ]. Prior to the COVID-19 pandemic, youth from single-parent households were more likely to seek mental health–related care [ 12 , 13 ]. Moreover, a single-parent household was also associated with lower adolescent sense of wellbeing and more anxiety and depressive symptoms during the COVID-19 pandemic compared to two-parent households [ 14 ].…”

Household food insecurity and health service use for mental and substance use disorders among children and adolescents in Ontario, Canada

“…Children and adolescents from marginalized groups have been shown to have poorer access to mental health care; 29 therefore, we have likely underestimated the magnitude of association between household food insecurity and health service use for mental and substance use disorders. Food insecurity is a marker for more widespread and pervasive material deprivation; 1 although it is plausible that household food insecurity may be a direct cause of mental and substance use disorders, 30 it is likely to be a marker of risk for a myriad of interconnected socioeconomic factors that contribute to mental and substance use disorders among children and adolescents.…”