Trends and disparities in unmet childhood mental health care needs: Analysis of National Survey of Children's Health 2016-2020

Abstract

Background: With 20% of children experiencing mental health disorders, it is critical to ensure mental health care (MHC) is accessible to all children. The COVID-19 pandemic created unique challenges in MHC delivery and accessibility. Therefore, assessing trends in children’s unmet MHC needs from 2016– 2020 may aid in developing strategies to overcome barriers to MHC.

Objective: Our primary objective is to analyze the trends in unmet needs among the pediatric population from 2016-2020. Our secondary objectives are to identify 1) the disparities among age groups, race/ethnicity, insurance coverage, or urbanicity that exist within the time frame, 2) the changes among each state over this time period, and 3) the potential effects of the COVID-19 pandemic.

Design and Methods: We conducted an observational study of the National Survey of Children’s Health to estimate five-year trends of unmet MHC needs. To identify state-level trends, we calculated each state’s percent change between 2016-2019 and 2019-2020 to determine the impact of COVID-19. Lastly, we measured associations, via logistic regression, between children’s unmet MHC needs and demographic factors to assess disparities.

Results: Between 2016 and 2019, the percentage of children with unmet MHC needs ranged from 17.28% to 22.22%. Nevada had the highest rates of unmet MHC needs at 28.72%, while Montana had the lowest rates of unmet MHC needs at 10.92%. Children between the ages of 3-5 were significantly more likely (AOR: 1.62; CI 1.13-2.33) to have unmet MHC needs than ages 6-10, while adolescents 15-17 were much less likely (AOR: 0.84 95%CI: 0.65-1.08). Compared to White children, Black children were significantly more likely to have unmet MHC (AOR:1.91; CI:1.46-2.50). Unmet MHC was also significantly associated with household income but not urbanicity.

Conclusions: From 2016-2020, there were no significant improvements in unmet MHC needs among children; however, disparities in receiving MHC exist, primarily among Black children and those between the ages of 3-5. Efforts to improve the accessibility of MHC through advocacy, optimized payment options, and expansion of evidence-based programs targeting groups most likely to have unmet MHC needs may improve children’s mental health outcomes.