Table 2.
Summary of main sample characteristics across the reviewed studies.
| Lead author, year | Sample characteristics | Mental disorders | Measure of mental disorders | Prevalence of mental disorders | Measure of service use | Prevalence of service use | Racial/ethnic disparities in service use* |
|---|---|---|---|---|---|---|---|
| Alegria, M. 2004 (35) | 1,885 caregiver-child dyads; children aged 4–18; 100% Puerto Rican | Depression, anxiety, and disruptive disorders | Computerized Diagnostic Interview for Children-IV (DISC-IV) | 2.4% for depressive disorders; 11.5% for disruptive disorders: 6.5% for anxiety disorders; 22% for significant impairment | Use of school sector services and use of mental health sector services (yes/no) | School sector: 9% of males, and 5% of females; mental health sector: 8% of males, and 4% of females | N/A |
| Anyon, Y. 2014 (31) | 8,466 high school students (9th−12th grade); 47% receiving free or reduced lunch; 20% English learners; 58% Asians; 15% Hispanics; 9% African Americans; 6% Whites; 3% Pacific Islanders; 11% multiracial | Depressive symptoms, anxiety, substance abuse | The California Healthy Kids Survey | 100% diagnosed. Top three presenting issues: anxiety (27%), family issues (21%), and depression (20%) | Use of counseling and case-management services through the school-based mental health prevention initiative (yes/no) | 34% of Asians; 63% of African Americans; 60% of Hispanics; 44% of Whites; 53% of Pacific Islanders; 52% of multiracial/other groups | Higher rates among African American (+); Hispanics (+); and other/ multiracial (+) groups compared to Asians Lower rates among Cambodian (–) and higher rates among other Asian groups (+), compared to Chinese |
| Anyon, Y. 2013 (36) | 1,744 high school students (9th−12th grade); 42% Chinese Americans; 20% Latino; 9% Whites; 7% African Americans; 15% other Asian ethnic groups; 4% multiracial | Depression, suicidality, and substance abuse | Youth Risk Behavior Survey | Not reported | Use of school-based services (yes/no) | Of those who received services: 24% of Chinese; 27% of Hispanics; 20% of African Americans; 7% of Whites; 11% of other Asians; 5% of multiracial groups | Lower rates among Chinese (–) compared with Blacks |
| Assari, S. 2017 (37) | 1,170 Black youth 13–17 years old; 69% African Americans; 31% Caribbean Blacks | Lifetime (non-psychotic) psychiatric disorders | Composite International Diagnostic Interview (CIDI) | Not reported | Medical person (yes/no) | Not reported | Lower rates among Caribbean Blacks (–) compared with African Americans |
| Ballard, E. 2013 (38) | 442 children aged 8–18; 53% male and 47% female; 85% with public or no insurance; 21% in foster care; urban setting; 91% African Americans; 9% other race/ethnicity groups | Any psychiatric chief complaint | Emergency department intake records | 100% presented with a psychiatric chief complaint to the pediatric ED; Positive suicide screen: 50% of adolescents, 48% of children | Hospitalized at index emergency department (ED) visit (yes/no) and returned to the ED for psychiatric reason (yes/no) | 100% of participants used services | N/A |
| Bannon, W. 2008 (30) | 96 parents of children aged 9- 14; mean parent age of 34; 93% mothers; 79% high school education; urban setting; 100% African Americans; 62% low-income; 95% subsidized housing | Internalizing and externalizing behaviors | Child Behavior Checklist (CBC-L) | 39% of children met criteria for a clinically significant degree of externalizing behavior | CHAMP Service Use Questionnaire e.g., “Did you ever take your child for counseling?” (yes/no) | 14% of parents reported using child mental health services | N/A |
| Burnett-Zeigler, I. 2010 (39) | 85 youth-caregiver dyads; 90% female caregivers; children aged 5–18; low income; 40% female; 68% African Americans; 7% Hispanic; 2% Whites; 22% other groups | Serious emotional disturbances | Not reported | 100% identified as having a serious emotional disturbance | Days of service use (school-based mental health intervention) | 100% of sample used services | Lower rate in African Americans (–), compared to non-African Americans |
| Carson, N. 2011 (40) | 252 outpatient charts of youth aged 3–20 from 5 clinical sites in a community mental health system; urban setting; 32% Haitian; 33% African Americans; 35% non-Latino Whites | ADHD, adjustment disorder, and depression | Child and Adolescent Needs and Strengths-Mental Health measure (CANSMH) | 73% of Haitians, 73% of African Americans, and 63% of Whites met the definition of clinical need | Adherence to treatment (total number of sessions during the first 6 months of treatment) | 100% of sample used services | Higher rate among the Whites (+), compared to Haitians |
| Carson, N. 2010 (29) | Medical records of 948 youth aged 3–20; urban setting; 86% Whites; 8% African Americans; 5% Haitians | ADHD; depression; anxiety | Medical records |
Haitian: ADHD 33%; depression 38%; anxiety 9% African American: ADHD 32%; depression 39%; anxiety 15% |
Adequate mental health treatment (receipt of at least 8 outpatient psychotherapy visits); Emergency room (ER) use (yes/no); | Receipt of adequate treatment: 43% of Whites; 39% of Haitians, 44% of African Americans ER visits: 28% of Whites; |
Higher rate of ER visits among African Americans (+); less use of psychopharmacological services by Haitian and African American youth (–) |
| Whites: ADHD 34%; depression 32%; anxiety 24% | Early treatment dropout (first gap in treatment for those individuals with fewer than 8 visits) | 30% of Haitians; 49% of African Americans | |||||
| Erath, S. 2009 (41) | 399 children aged 5–16; 51% female; 28% living with single mothers; 85% European Americans; 15% African Americans | Internalizing and externalizing behaviors | CBCL | In kindergarten: 21% showed symptoms of internalizing problems; 15% showed symptoms of externalizing problems | Use of any type of mental health service (yes/no), age of first use, and type of service | 31% received services | Higher rate in Whites (+), compared to African Americans |
| Fisher, J. H. 2018 (42) | 187 adolescents aged 12–18; 60% Hispanic; 21% African Americans; 15% Multiracial; 4% Other | Oppositional defiant disorder, conduct disorder, ADHD, mood disorder Generalized anxiety disorder, PTSD, Substance use disorder. | Adolescent-reported Youth Self-Report (YSR); caregiver reported CBCL | 86% oppositional defiant disorder, 53% conduct disorder, 71%ADHD, 41% mood disorder 17% Generalized anxiety disorder, 18% PTSD, 29% Substance use disorder. | Intake attendance defined as attending an intake session at the assigned treatment site. Treatment initiation defined as the completion of an initial treatment session after completing the full intake process at the assigned treatment site. |
100% were linked to services | N/A |
| Frosch, E. 2011 (43) | 338 youth with a mean age of 12.6; 44% female; urban setting; 82% Medicaid enrolled; 80% African Americans | Mood disorder, disruptive behavior disorder, ADHD, parent-child relationship problem, anxiety disorder, adjustment disorder, substance use disorder, developmental disorder, psychosis disorder | Pediatric Psychiatry Emergency Evaluation Form (PPEEF) | 100% had repeat visit to emergency department | Connection with an outpatient mental health provider (yes/no) | 65% had connection with outpatient mental health provider | N/A |
| Goldstein, A. 2007 (44) | 417 youth aged 4–18; 45% female; urban setting; 80% African Americans | Any type of mental disorders (disruptive behaviors most frequent) | Standardized written clinical assessments | 100% made mental health visits to an urban pediatric emergency department | Six-month recidivism (return emergency department) | 100% of sample used services | Higher rate in African Americans (+), compared to Whites |
| Gudino, O. G., 2008 (45) | 457 youth ages 11–18; 70% males; 80% Hispanic, 20% Asian | Internalizing and externalizing behavior disorders | DISC-IV; CBCL; youth self-report | 18.8% internalizing disorders; 30.9% externalizing disorders | Use of specialty and school-based mental health service use assessed prospectively over 2 years using the Services Assessment for Children and Adolescents | In general, 36.4% used specialty mental health services; 46.0% used school mental health services | Higher rates of specialty service use for Hispanics (+) compared with Asians |
| Gudino, O. G., 2009 (46) | 1,108 youth aged 11–18; 33% female; 38.7% White; 29.3% Hispanics; 22.7% African Americans; 9.3% Asians; median household income $20,000–$24,999 | Internalizing and externalizing behavior disorders | DISC-IV; CBCL; youth self-report | 9% internalizing disorders; 21% externalizing disorders | Use of specialty and school-based mental health service use assessed prospectively over 2 years using the Services Assessment for Children and Adolescents | Use of specialty services: 57% of Whites; 46% of African Americans; 43% of Hispanics; 25% of Asians Use of school services: 66% of Whites; 64% of African Americans; 54% of Hispanics; 41% of Asians |
Higher service rate in Whites (+) for internalizing symptoms Higher service rate in Blacks (+) for externalizing symptoms |
| Guo, S. 2014 (26) | 1,917 students with a mean age of 12.6; 51% female; urban setting; 45% Hispanic; 49% Asians; 6% other racial/ethnic groups | Internalizing and externalizing behavior disorders | Strength and Difficulties Questionnaire (SDQ) | 23% met criteria for at least one type of emotional or behavioral problem | Referral to school services (yes/no); receipt of treatment upon referral (yes/no); engagement in treatment (total number of sessions attended) | Referral to services: 20% of Asians; 73% of Hispanics | Higher referral rate in Hispanics (+), compared to Asians; No differences in receipt of treatment after referral |
| Guo, S. 2015 (25) | 169 adolescents (10th and 11th grades); 54% female; 59% Vietnamese Americans; 41% European Americans | Emotional and behavioral symptoms | Youth self-report | Not reported | Help-seeking from potential support sources (e.g., friend, significant other, parents, teacher, mental health | Help-seeking from formal sources: 10% Europeans American; 4% Vietnamese Americans | Higher rate in European Americans (+), compared to Vietnamese Americans |
| professional, doctor, and religious/spiritual leader) (yes/no) | |||||||
| Ho, J. 2007 (33) | 1,364 youth ages 6–17; 44% non-Hispanic White; 20% African Americans; 7% Asian/ Pacific Islander; 28% Latinos | Internalizing and externalizing behavior disorders | DISC-IV; CBCL; youth self-report | Not reported; total problem score reported instead | Any use of specialty mental health services at 2-year follow-up | Not reported | Lower rates of specialty service use in Latinos (–) and Asians (–) compared with Whites |
| Howell, E. 2008 (47) | 65,348 youth Aged 6–17; Urban setting; 70% Whites; 15% Hispanics; 14% Black/African Americans; 1% Native Americans | Index of Mental Health Status | National Survey of America's Families | 7.5% with a mental health problem | Received psychological or emotional counseling in the last year (yes/no) | 8.5% Black; 17.3% Native American; 5.6% Hispanic | Rural regions: Hispanic (–) Urban regions: Hispanic (–) Black (–) Native Americans. (+) |
| Kim, R. 2016 (34) | 93 Latino youth ages 5–15 and parent dyads | Anxiety/trauma, depression, or disruptive behavior problems | Clinical diagnosis | 100% diagnosed | Session attendance, premature treatment termination, and treatment satisfaction in community-based mental health agencies | 100% receiving treatment | N/A |
| Kodjo, C. 2004 (27) | 13,570 adolescents with a mean age of 15.3 years; 50% female; 35% low-income; 67% White; 15% African Americans; 12% Hispanics | Emotional distress | Resnick's Emotional Distress Scale | 29% showed symptoms | Receipt of psychological or emotional counseling in the last year (yes/no) | 17% received psychological counseling in the year preceding Wave 2 | Lower rate in African Americans (–) compared to Whites and Hispanics (–) |
| Lindsey, M. 2010 (28) | 465 adolescents with a mean age of 14.8 years; 72% received free or reduced lunch; 46% female; 100% African Americans | Internalizing and externalizing behaviors | Teachers' report of whether the child need treatment or counseling | 19% had internalizing problems 29% had externalizing problems | Use of any type of mental health service (yes/no) as measured by the Services Assessment for Children and Adolescents; parent report | 6% currently used outpatient mental health services; 4% received school mental health services | N/A |
| Lindsey, M. 2010 (48) | 1,621 youth aged 22 and younger (54% aged 13–17); urban setting; 43% female; 75% with public insurance; 100% African American | Mood (e.g., major depression, dysthymia, and bipolar disorder); disruptive behavior (e.g., conduct, impulsive, ADHD); and “all other diagnoses” (e.g., anxiety disorders, psychosis, other non-depressive moods) | Patient records | 100% showed symptoms | Arrival status to the emergency department (involuntary vs. voluntary admission) and disposition (disposition upheld vs. dismissed) | 100% of participants used services | N/A |
| Malhotra, K., 2015 (49) | 20,970 adolescents aged 12–17; 43% female; 59% non-Hispanic White; 20% African Americans; 21% Hispanics | Externalizing behaviors | Six questions measuring the frequency of behaviors in the National Survey on Drug use and Health survey | 100% displayed externalizing behaviors; Medium severity behaviors: 36.5% of Whites; 40.7% of African Americans; 38.4% of Hispanics | Use of inpatient or outpatient services (yes/no) | Mental health clinic: 5% Whites; 3% African American; 3% Hispanics Therapist: 16% Whites; 10% African American; 11% Hispanics | Lower rate of outpatient service use: African Americans (–); Hispanics (–), compared to Whites |
| McCabe, K. 2002 (50) | 50 families with children aged 6–12; mostly low-SES; urban setting; 100% Mexican Americans; 58% of children reside in single parent family | Any type of outpatient mental health disorder | Not reported | 100% of families had children admitted for any type of outpatient mental health disorders | Treatment drop-out: parents who did not return after completing the intake or one session beyond the intake | 100% of participants used services | N/A |
| Merikangas, K. R. 2011 (13) | 6,483 adolescents aged 13–18; 49% female; 65.6% non-Hispanic Whites; 15.1% non-Hispanics Blacks; 14.4% Hispanics | Mood disorders (depression, bipolar); anxiety disorders, behavior disorders (oppositional defiant disorder, conduct | Composite International Diagnostic Interview 3.0 (CIDI 3.0) | 100% diagnosed | Use of any type of mental health service (yes/no) and type of service | 36% of the participants received services | Lower rate of service use in Hispanics (-), compared to Whites, for severe ADHD |
| disorders); ADHD; Any substance abuse (eating disorders, alcohol abuse/dependence, drug abuse/dependence) | |||||||
| Mukolo, A. 2011 (51) | 175 caregivers of African American youth aged 4–17 | Not reported | CBCL | 100% diagnosed | Caregivers reported the types settings where their child had received any behavioral health services over the past 6 months | 100% of the participants received services | N/A |
| Williams, C. D. 2011 (52) | 108 parent-adolescent dyads; Youth aged 10–17; 94% African Americans; 2% mixed races; 2% Latinos; 2% American Indians; 54% female | Internalizing and externalizing problems | DSM-IV | 100% diagnosed | Number of appointments kept | 100% of the participants received services | N/A |
| Yasui, M. 2015 (53) | 1,480 girls aged 15–17; 58% African American; 42% White | Conduct disorder, major depressive disorder | Child Symptom Inventory (CSI-4) | 1.9% European American girls and 4.4% African American girls diagnosed with conduct disorder; 2.6% European American girls and 3.1% African American girls diagnosed with major depressive disorder | Help-seeking from mental health professional or community service, or admittance to a hospital or in-patient clinic in the past year (yes/no) | 9.6% of Whites; 11.5% of African Americans | N/A |
| Yeh, M. 2005 (54) | 1,337 parents; Youth aged 6–17); 44.1% White; 28.8% Hispanic; 20.3% African American; 6.8% Asian and other | Internalizing and externalizing behavior disorders | DISC-IV; CBCL; youth self-report | Not reported | Any mental health services in the past year | 58.4% of youths reported specialty mental health service use | Lower rates of service use at 2-year follow-up among Asians (-) and Hispanics (-) compared with Whites |
| Yeh, M. 2019 (55) | 285 parent- youth dyads; Youth aged 12–18; 69.8% Latinx; 13.7% African American/Blacks; 5.6% Non-Hispanic White; 2.1% Asian American/ Pacific Islander; 0.4% American Indian/Alaska Native; 6.7% Multiracial | Not reported | Beliefs About Care Survey (BAC) | Not reported. | The Engagement Measure | 100% of the sample received school-based or clinic-based outpatient therapy | N/A |
| Zerr, A. A 2014 (32) | 242 parent-child dyads of children aged 4–16; 45% female; 48% Whites; 52% Hispanics | Anxiety | CBCL | 100% showed symptoms | Completion of a home screen; participation in on-site diagnostic assessment (yes/no) | 55% completed home screen; of those, 67% took on site diagnostic assessment | Completion of home screen: higher rate in Whites (+), compared to Hispanics |
(+) indicates statistically significant positive predictor; (–) indicates statistically significant negative predictor.