Demographic factors in the use of children's mental health services.

OBJECTIVES: This study was designed to (1) determine mental health service use by children of varying age, sex, socioeconomic status, and urbanicity of residence; (2) compare the prevalence of mental disorder in children in these groups; and (3) determine the extent to which differences in service use are consonant with the prevalence differences. METHODS: Data on psychiatric diagnoses and service use were taken from a random longitudinal sample of 760 children. Information was gathered by interviews of mothers and of youth aged 12 to 21. RESULTS: Significant lags in mental health service use were found for youth 18 to 21 years of age, for those living in rural and semirural areas, and for those in middle-income families. To some extent, these service use differences paralleled differences in diagnostic rates. However, when diagnostic differences were controlled, the same patterns of service use inequalities were present. CONCLUSIONS: Mental health service use rates for youth vary by age, urbanicity, and family income. The underservice of middle-income and rural children may reasonably be ascribed to access problems; we explore explanations for the underservice of older youth.