The Mental Health Care Gap among Children and Adolescents: Data from an Epidemiological Survey from Four Brazilian Regions
Open accessAbstract
INTRODUCTION: Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy. OBJECTIVES: To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU. METHODS: Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721). Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1) children/adolescent characteristics [(1.1) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)-psychiatric disorders; (1.2) Ten Questions Screen-neurodevelopment problems; (1.3) two subtests of WISC-III-estimated IQ; (1.4) Academic Performance Test-school performance)], (2) factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression), (3) family (Brazilian Research-Companies-Association's Questionnaire-SES). RESULTS: Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions) regardless of the presence of any psychiatric disorders/neurodevelopmental problems. CONCLUSIONS: Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental health specialist in the previous 12 months. Structural/psychosocial/demographic factors were associated with uneven access to service for certain groups of children/adolescents. These results call attention to the urgent need to implement programs to help reduce this large unmet mental health need; inequalities must be considered by policy makers when planning strategies to address barriers for care.
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The study found a very similar rate of unmet needs compared to Paula's epidemiological study in small Brazilian cities (80.2% vs. 81.0%).
“We found a very similar rate of unmet needs when compared to Paula's epidemiological study conducted in small Brazilian cities (80.2% vs. 81.0%) (7).”
From Use of mental health services by children with mental disorders in two major cities in Brazil (2019) · cites this paper as [7]
The Setting describes a survey in four small Brazilian towns. Results Table 2 reports that 80.2% of children and adolescents with a psychiatric disorder had not used mental health services in the previous 12 months, supporting the comparison of similarly high unmet need. It does not report 81.0% as Paula’s rate; in the citing sentence’s ‘80.2% vs. 81.0%’ ordering, that figure appears to be attributed to Paula. (LLM, conf=0.87)
Experimental — accuracy not yet measuredTo date, only two studies in Brazil described children and adolescents mental health service use.
“To date, only two studies in Brazil described children and adolescents mental health service use.”
From Use of mental health services by children with mental disorders in two major cities in Brazil (2019) · cites this paper as [7]
The Introduction says empirical data on mental health service use among Brazilian children and adolescents are lacking and describes this as the first Brazilian multicenter study on the topic. That supports the claim that research was limited, but neither the Introduction nor the Discussion establishes that exactly two Brazilian studies had described service use. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAn epidemiological study in four small cities in four Brazilian regions (N=1,721) found that 80.2% of children and adolescents with mental disorders measured by a diagnostic instrument did not receive treatment.
“An epidemiological study conducted in four small cities located in four Brazilian regions (N=1,721) found 80.2% of children and adolescents with mental disorders measured by a diagnostic instrument did not receive treatment (7).”
From Use of mental health services by children with mental disorders in two major cities in Brazil (2019) · cites this paper as [7]
The Abstract Methods report a sample of 1,721 across four Brazilian towns and assessment of psychiatric disorders with K-SADS-PL. The Abstract Results report that 19.8% of children and adolescents with a psychiatric disorder used mental health services, implying 80.2% did not. However, the paper measures visits to specified mental health professionals in the previous 12 months, not whether children received any treatment at all. (LLM, conf=0.85)
Experimental — accuracy not yet measuredBoth prior Brazilian studies did not evaluate details about treatments, such as modality, duration, specific medications, and providers.
“Both studies did not evaluate details about treatments, such as modality, duration, specific medications, and providers.”
From Use of mental health services by children with mental disorders in two major cities in Brazil (2019) · cites this paper as [7]
The Discussion (page not provided) says service-use information lacked details such as the number of consultations, supporting the claim that some treatment details were not evaluated. But Materials and Methods identifies the provider types studied, and the Discussion reports that psychologists offered 84.9% of appointments. The claim is therefore inaccurate about providers; this copy cannot establish what the other study evaluated. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe only other study that sought to identify correlates of unmet needs in Brazil did not assess child race.
“Since the only other study that sought to identify correlates of unmet needs in Brazil did not assess child race, we are not able to compare our results (7).”
From Use of mental health services by children with mental disorders in two major cities in Brazil (2019) · cites this paper as [7]
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References 48 · Cited by 88
Research works printed but not linked: 1
- [45]Razzouk D (2013) Economia da saúde aplicada à saúde mental. In: Mateus M, editor. Política de saúde mental. São Paulo: Imprensa Oficial do Estado de São Paulo; Instituto de Saúde. pp. 232–254.
- Authors
- Paula, C. S., Bordin, I. A. S., Mari, J. J., Velasque, L., Rohde, L. A., & Coutinho, E. S. F.
- Affiliations
- Universidade Presbiteriana Mackenzie (BR)
- Universidade Federal de São Paulo (BR)
- Universidade Federal do Estado do Rio de Janeiro (BR)
- Escola Nacional de Saúde Pública Sergio Arouca (BR)
- Corresponding author
- Paula, Cristiane S.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-02-18
- Volume
- 9
- Issue
- 2
- Pages
- e88241
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3928169
- OpenAlex
- W2037208742
- Cited by
- 88
- References
- 48
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 15 · 2020: 5 · 2019: 5 · 2018: 14 · 2017: 4 · 2016: 9 · 2015: 4 · 2014: 1
- FWCI
- 8.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (acceptedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- Americanae (AECID Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lume (Universidade Federal do Rio Grande do Sul) (submittedVersion, cc-by-nc-sa)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, public-domain)
- Greater South Information System
- Funders
- Eli Lilly and Company
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Conselho Nacional de Desenvolvimento Científico e Tecnológico
- Cilag
- 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 › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- child and adolescent mental health, mental health service utilization, access to mental health care, barriers to care, mental illness, neurodevelopmental problems, socioeconomic status, maternal anxiety and depression, academic performance, gender differences, regional deprivation, Brazil
- MeSH terms
- Adolescent, Mental Disorders, Brazil, Child, Child Guidance, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Male, Mental Health, Mental Health Services, Surveys and Questionnaires, Social Class, Reproducibility of Results, Healthcare Disparities
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