The majority of adolescents in need of mental health care do not receive any services. Although a large body of literature has identified numerous individual factors associated with adolescent mental health service use, there is a paucity of information concerning the role of contextual factors that affect their use of services. Using baseline data from the National Longitudinal Study of Adolescent Health, this study addresses this gap in the literature by examining the relationships among contextual ...
The majority of adolescents in need of mental health care do not receive any services. Although a large body of literature has identified numerous individual factors associated with adolescent mental health service use, there is a paucity of information concerning the role of contextual factors that affect their use of services. Using baseline data from the National Longitudinal Study of Adolescent Health, this study addresses this gap in the literature by examining the relationships among contextual racial/ethnic composition, contextual socioeconomic status, and adolescents' use of mental health counseling across settings. This study uses multivariate logistic regressions and a population average approach to examine the impact of several contextual sociodemographic measures at the county and tract level on counseling service use. Analyses revealed strong positive relationships between the socioeconomic status of the county and the census tract and the receipt of mental health counseling in clinical settings among adolescents. At the county-level, results provide limited evidence that the supply of mental health specialists may, in part, mediate this positive relationship. These relationships were observed for the full analytic sample of adolescents as well as subpopulations that were identified with high levels of mental health need. The racial/ethnic composition of the county and tract, however, does not generally appear to be associated with the use of clinical counseling services. When examining the receipt of counseling services in a school setting, analyses revealed that adolescents living in socioeconomically disadvantaged census tracts were more likely to receive school-based counseling, although those living in counties with high levels of socioeconomic inequality were less likely to receive school-based counseling. Finally, analyses revealed a positive relationship between the concentration of Hispanic residents in the county and the census tract and the receipt of school-based counseling. These relationships were observed for the full analytic sample and subpopulations with high levels of mental health need. The findings from this research provide evidence that schools may be the best setting in which to provide mental health services if the objective is to reduce the unmet need for mental health care among adolescents living in disadvantaged and/or ethnically diverse communities.
Product dimensions: 7.44 (w) x 9.69 (h) x 0.67 (d)
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