Ethnic differences in utilization of youth mental health care.

OBJECTIVES: There is an overall underutilization of youth mental health care (YMHC). It is unknown whether underutilization differs per ethnic group. Therefore, this study is aimed at gaining insight into the effects of ethnicity, age and gender on this utilization. DESIGN: The sample consisted of outpatient children (age 5-10) (n=1940) and adolescents (age 11-19) (n=2484) admitted to a Dutch YMHC centre. Ethnic background of the patients (patient registration system) was compared to that of the general population (municipality files). Relative risks (RRs) on utilization for non-native groups were calculated with natives as the reference group. RESULTS: With regard to children, female children from Moroccan, Turkish and other non-native western descent were less likely to enter mental health care than native Dutch female children. The RR was 0.24 for Moroccan girls, 0.53 for Turkish girls, and 0.60 for girls from other non-native western countries. Male children from almost all non-native groups were also less likely to enter mental health care than native Dutch male children, with the RRs being between 0.43 and 0.65. With regard to adolescents, most non-native adolescents, were as likely as native adolescents to enter mental health care. An exception were males and females from Morocco and males from Turkey and non-native western countries, who were less likely than Dutch adolescents to enter mental health care (RRs between 0.61 and 0.80). CONCLUSION AND DISCUSSION: Results imply that YMHC is less accessible for children from a minority background than for children from a native background. With adolescents, there is no difference in accessibility between natives and non-natives. Future research should focus on the reasons for this difference in accessibility. Potential mediators such as socioeconomic status, discrimination, acculturation processes, language barriers should be taken into account.

[Refugees and mental health - what can doctors do?] / De psychische gezondheid van vluchtelingen: onze zorg.

The influx of Ukraine refugees confronts doctors with the effects of forced migration. Refugees are at risk for the development of mental health problems, due to traumatic experiences and unfavorable living circumstances post-migration (poverty, unemployment). Person-centered cultural sensitive care contributes to timely recognition and treatment of mental distress. To be effective, trust must be built through continuity of care and respectful attention to personal wishes and circumstances of the refugee. Other important aspects are the involvement of a professional interpreter, pro-active discussion of social problems and always performing a physical examination. Health education about symptoms of distress, and how to best cope with these, is helpful for refugees and families supporting refugees. For this, educational materials in different languages are available. With a little bit of extra time and effort doctors can play an important role in improving the wellbeing of refugees.

A review of mental health treatment dropout by ethnic minority youth.

A large proportion of treatments in youth mental health care are prematurely terminated by the patient. Treatment dropout can have severe consequences. Since ethnic minority youth are treated less often for mental disorders than other youth, it is important to analyse their risk for dropout and to determine if there are ethnicity-specific determinants. This review aimed to provide an overview of the findings from empirical studies on child and adolescent therapy dropout by ethnic minority and to determine if there were ethnicity-specific dropout determinants. An extensive literature search was performed to locate relevant journal articles. Identified articles were inspected for relevant references and these articles were then included in the meta-analysis. A total of 27 studies were accepted for analysis. The results showed that ethnic minority patients have a higher risk of treatment dropout than ethnic majority patients and that dropout rates are ethnically specific. Several differences in dropout predictors among the ethnic groups were found. In spite of diverse results, review limitations, and the lack of several key variables in the available research, some clinical recommendations are made. The review indicates that to prevent dropout, therapists should pay attention to variables such as ethnic background, therapist-patient ethnic match, and the quality of the therapeutic relationship.

A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care.

A large proportion (28% up to 75%) of the treatments in youth mental health care results in premature termination (dropout). It is important to gain knowledge of the determinants of dropout because it can have very severe consequences. The aim of our meta-analytic review was to provide an overview of findings from empirical studies on this subject. We structured the often contradicting results from two perspectives. First, we compared studies with efficacy and effectiveness designs. Second, we compared studies which used a dropout definition based on the opinion of therapists, with those that took the number of predetermined completed sessions as a criterion. Third, we studied three groups of predictors, i.e., pre-treatment child variables, pre-treatment family or parent variables, and treatment and therapist variables or treatment participation barriers. The meta-analytic review showed that dropout percentages were strongly influenced by study design: Percentages were lower in efficacy than in effectiveness studies. Within effectiveness studies, the dropout percentages were lower when the therapist's opinion was used rather than when the number of sessions was used as a criterion. In efficacy studies on the contrary, the dropout percentages were similar for studies using the first or the second criterion. With respect to dropout predictors, results were less clear. Some of the dropout predictors were influenced by study design or dropout definition, but for most predictors this influence could not be analyzed because they were not studied in all groups of studies or because the effect sizes were small or non-significant. Treatment and therapist variables or experienced treatment participation barriers were overall stronger dropout predictors than the pre-treatment child variables and pre-treatment family or parent variables, although some strong predictive pre-treatment variables emerged as well.