Factors Associated With Child Mental Health Service Use in the Community

To determine the association of parent, family, and child factors with mental health services need and utilization. Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples. J. Am. Acad. Child Adolesc. Psychiatry, 1997, 36(7):901–909.