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Behavioral Predictors of Mental Health Service Utilization in Childhood Through Adolescence

Erath, Stephen A. PhD*; Keiley, Margaret K. EdD*; Pettit, Gregory S. PhD*; Lansford, Jennifer E. PhD; Dodge, Kenneth A. PhD; Bates, John E. PhD

Journal of Developmental & Behavioral Pediatrics: December 2009 - Volume 30 - Issue 6 - p 481-488
doi: 10.1097/DBP.0b013e3181c35938
Original Article

Objectives: This study investigated predictors of mental health service utilization from age 5 through age 16.

Methods: Data were collected on a community sample of 399 children, including 338 European Americans and 61 African Americans. Internalizing and externalizing behaviors were assessed by maternal and teacher reports in kindergarten. History of mental health service utilization was assessed by maternal reports when participants were 16 years old.

Results: On average, the probability of first-time mental health service utilization increased in early to middle childhood, stabilized, and then increased in early adolescence. Mother reports of internalizing behaviors (independent of teacher reports of externalizing behaviors) predicted an increased likelihood of service use among European American children but a decreased likelihood of service use among African American children. Externalizing behaviors (independent of internalizing behaviors) predicted a higher likelihood of first-time service use in middle childhood. The combination of elevated internalizing and externalizing behaviors predicted a higher likelihood of first-time service use in adolescence, mainly among European American children.

Conclusions: This study provides evidence that elevated mother-reported internalizing behaviors are less likely to forecast mental health service utilization among African American children compared with European American children. To meet the mental health service needs of all children, it is critical to further examine reasons for service utilization and underutilization among children with internalizing problems.

From the *Department of Human Development and Family Studies, Auburn University, Auburn, AL; †Center for Child and Family Policy, Duke University, Durham, NC; ‡Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN.

Received December 17, 2008; accepted September 22, 2009.

The Child Development Project has been supported by grants from the National Institute of Mental Health (MH 42498, MH 56961, MH 57024, and MH 57095), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD 30572), and the National Institute on Drug Abuse (DA 16903).

Address for reprints: Stephen A. Erath, PhD, 203 Spidle Hall, Auburn University, AL 36849; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.