Racial and Ethnic Disparities in Caregiver Strain and the Use of Child Mental Health Services: A Structural Equation Model
Abstract
OBJECTIVE: Although racial and ethnic disparities in the use of child mental health services have been well documented, the causes of and solutions to these disparities are not clearly understood. This study examined the role of caregiver strain in the disproportionately low rates of services use among youths from racial or ethnic minority groups who had already had contact with public service systems. METHODS: This cross-sectional study used secondary analysis of a stratified random sample of 1,370 youths from the Patterns of Youth Mental Health Care in Public Service Systems Study, who were involved with at least one of five public sectors of care. Caregiver strain and use of child mental health services in the past 12 months were assessed by the Caregiver Strain Questionnaire and the Service Assessment for Children and Adolescents, respectively. A structural equation model that examined the mediating role of caregiver strain for use of child services among three racial and ethnic groups was evaluated for goodness of fit. RESULTS: African-American caregivers reported lower levels of caregiver strain than did non-Hispanic white caregivers; Hispanic caregivers did not differ significantly from non-Hispanic white caregivers on reporting caregiver strain. Among African Americans, the effects of race on use of services were indirect, mediated through caregiver strain. CONCLUSIONS: Findings emphasize the importance of culturally influenced perceptions of caregiving practices and burden among caregivers of a child with emotional or behavioral problems. Intervention efforts to reduce disparities in use of services across racial or ethnic groups need to be informed by a better understanding of the causes of group differences in reporting caregiver strain and the relationship between reported caregiver strain and use of child mental health services.
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Dimensions of caregiver strain among Latinxs are an important culture-bound pathway by which parents become aware of the need for formal youth MHS and decide to seek support.
“Recent research has suggested that dimensions of caregiver strain among Latinxs, or stress resulting from caring for a youth with emotional and/or behavioral problems are an important culture-bound pathway by which parents become aware of the need for formal youth MHS and decide to seek support [4,6].”
From Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs (2024) · cites this paper as [4]
Shin and Brown's analysis primarily focused on understanding racial/ethnic differences in caregiver strain on youth MHS use and did not examine indirect pathways between youth mental health service need and MHS utilization through subtypes of caregiver strain.
“While this research controlled for mental health service need, the analysis primarily focused on understanding racial/ethnic differences in caregiver strain on youth MHS use and did not examine indirect pathways between youth mental health service need and MHS utilization through subtypes of caregiver strain (e.g., objective, subjective internalized, subjective externalized).”
From Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs (2024) · cites this paper as [4]
Shin and Brown examined global caregiver strain as a mediator between caregiver race/ethnicity and a latent factor representing utilization of multiple MHS.
“Shin and Brown [4] examined global caregiver strain as a mediator between caregiver race/ethnicity (i.e., Latinx and Black relative to White) and a latent factor representing utilization of multiple MHS (i.e., specialty inpatient and outpatient, non-specialty outpatient, school-based services).”
From Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs (2024) · cites this paper as [4]
Research has connected these findings through the examination of global caregiver strain as a potential mediator between youth problems and cumulative MHS utilization.
“Research has connected these findings through the examination of global caregiver strain as a potential mediator between youth problems and cumulative MHS utilization [4]”
From Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs (2024) · cites this paper as [4]
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References 35 · Cited by 33
- Authors
- Shin, S. H., & Brown, T. A.
- Affiliations
- Boston University (US)
- Venue
- Psychiatric Services
- Published
- 2009-08
- Volume
- 60
- Issue
- 8
- Pages
- 1039-1045
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2067648649
- Cited by
- 33
- References
- 35
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 3 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 5 · 2012: 4
- FWCI
- 3.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- National Institutes of Health
- National Institute of Mental Health (U01-MH55282, U01MH055282)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- racial and ethnic disparities, caregiver burden, child mental health services, service utilization, African American caregivers, Hispanic caregivers, emotional and behavioral problems, public mental health services, mediation
- MeSH terms
- Adolescent, Child, Cross-Sectional Studies, Female, Humans, Male, Mental Health Services, Surveys and Questionnaires, Stress, Psychological, Models, Statistical, Caregivers, Racial Groups, Young Adult
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