Study confirms that caregiver strain is associated with racial and ethnic disparities in the use of child mental health services
As our nation increasingly observes a rapid growth in minority youth populations, its health care system faces new challenges with the diverse needs of these groups. While racial and ethnic disparities in child mental health services have been well documented, there is much room for further understanding of what precipitates services use among children, and whether it varies across racial and ethnic groups. For instance, there is a definite lack of knowledge about the family characteristics of racial or ethnic minority populations that might have direct impact on child service use. There is also lack of information about the relationships between racial or ethnic variations in caregiving or parenting experiences and use of mental health services by youth.
In a new study, “Racial and Ethnic Disparities in Caregiver Strain and the Use of Child Mental Health Services: A Structural Equation Model,” Boston University School of Social Work Assistant Professor Dr. Sunny Shin, together with BU Psychology Professor Timothy Brown, PsyD, sought to explore the role of caregiver strain in the use of child mental health services across racial and ethnic groups. The study was published in Psychiatric Services and is available online.
In the last few years, research on child mental health services has paid more attention to the role of caregiver strain (often referred to as ‘caregiver burden’ or ‘family impact’) in services use. Studies have found that caregivers’ perceptions of the burden or impact of caring for a child with an emotional or behavioral problem influence the child’s access to care (particularly outpatient services, where access to services in which parental involvement is necessary for services use). Few studies, however, have examined the relationships between racial or ethnic variations in caregiver strain and use of services.
“It is possible that variability in caregivers’ culturally influenced perceptions of caregiver strain can certainly lead to different rates of services use,” says Dr. Shin.
In fact, this new study revealed that racial and ethnic differences in caregiver strain would explain why youths from racial or ethnic minority groups have greater unmet needs than do non-Hispanic white youths. As Dr. Shin reports, “In the study, youths whose caregivers felt lower levels of caregiver strain were less likely to use mental health services…compared with non-Hispanic white caregivers, African-American caregivers had lower levels of caregiver strain. We found that caregiver strain mediated the relationship between being African American and use of mental health services.”
“The findings of this study support the importance of culturally influenced cognitive aspects of the caregiving experience, such as perceptions of caregiver strain, in explaining racial and ethnic differences in child services use,” he adds. He emphasized that given that caregivers are the main identifiers of children’s mental health problems and have an important influence on a child’s entry into services, mental health research need to pay increasing attention to the way in which cultural and family values influence the motivation of caregivers to seek professional treatment for their children.
Dr. Shin’s findings clearly suggested to him that cultural and family contexts in which a child’s emotional or behavioral problems are recognized and in which medical advice is sought and provided “may play an important role in racial or ethnic disparities.” He emphasized that there is a definite need to examine the variation in these factors in order to reduce racial or ethnic disparities in use of professional mental health services.