Ethnic Differences in Perceived Impairment and Need for Treatment in Children

Author: Ligia M. Chavez Rodriguez, PhD, Patrick E. Shrout, PhD, Rafael Ramírez, PhD, Glorisa Canino, PhD

Background: This paper investigates beliefs about what is impaired behavior, the severity of the behavior and the need for treatment within and across three groups: Puerto Rico, US-Latino and non-Latino white, parents and providers. The information generated has important implications for improving access and retention to mental health services for Latino children.

Method: Using a vignettes based methodology we systematically varied the influence of type of mental health problem (internalizing or externalizing), child’s ethnicity (Latino-Non-Latino white), gender and level of impairment (borderline or moderate), and collected ratings to study parents’ and providers’ reactions to those characteristics. We asked participants to rate six vignettes – two calibration vignettes plus four experimental vignettes. Data collection was conducted in both Boston and Puerto Rico. We used an incomplete block design on the vignettes to provide a balanced representation of all possible vignette permutations.

Results: For providers, results indicated that having an internalizing disorder predicted a lower rating in need for medication and less impairment as rated by the Children’s Global Assessment Scale (C-GAS). In addition, we also found that US non-Latino provider’s gender was a significant predictor of rating the need for medication. A male provider was associated with a higher rating of need for medication. For Puerto Rican parents, results were similar to those of providers in that having an internalizing disorder was consistently rated as less serious, with a lesser need for mental health services and medication.

Conclusions: Preliminary findings suggest a greater need to recognize the symptoms associated with having internalizing vs. externalizing disorders. A fuller understanding of ethnic differences is a necessary step to develop disparities interventions, outreach efforts and/or health literacy campaigns to increase parent’s and provider’s level of awareness of children’s mental health problems and need for treatment.