Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

Tierra D Burrell; Seohyun Kim; Karishma Mohadikar; Cabell Jonas; Nancy Ortiz; Michael A Horberg

doi:10.1016/j.jadohealth.2023.01.018

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

J Adolesc Health. 2023 Oct;73(4):693-700. doi: 10.1016/j.jadohealth.2023.01.018. Epub 2023 Apr 8.

Authors

Tierra D Burrell¹, Seohyun Kim², Karishma Mohadikar², Cabell Jonas², Nancy Ortiz³, Michael A Horberg²

Affiliations

¹ Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland; Department of Pediatrics, MAPMG, Rockville, Maryland. Electronic address: Tierra.D.Burrell@kp.org.
² Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland.
³ Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland.

Abstract

Purpose: This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization.

Methods: Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence.

Results: Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ² = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic.

Discussion: Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

Keywords: Adolescent mental health; COVID-19 pandemic; Family structure; Mental health service utilization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
COVID-19*
Female
Humans
Infant
Male
Mental Disorders* / epidemiology
Mental Disorders* / psychology
Mental Disorders* / therapy
Mental Health Services*
Pandemics
Retrospective Studies