Rates of child DSM-IV psychiatric diagnoses
Of the 333 children included in the present analysis, 79 (23.7%) met criteria for a current DSM-IV diagnosis at the time of the assessment. Some 16 (4.8%) children met criteria for a mood disorder, 38 (11.4%) for an anxiety disorder (specific phobia not included), 21 (6.3%) for ADHD, and 24 (7.2%) met criteria for a disruptive behaviour disorder. Over a quarter of children with psychiatric disorder experienced comorbidity (26.6%), which ranged from two to five diagnoses.
Rates of service use
Of those children with a DSM-IV diagnosis at the time of interview (n = 79), only 29 (36.7%) accessed services in the 3 months prior to interview due to concerns about their emotions or behaviour. A fifth (n = 17, 21.5%) had been in contact with medical services and 21 (26.6%) with non-medical services (). Of the 79 individuals with a psychiatric disorder at the time of interview, 48 (60.8%) had been in contact with services at some point in their lifetime — 33 (41.8%) had been in contact with medical services, and 38 (48.1%) in contact with non-medical services.
Percentage of children with and without psychiatric disorder accessing the different types of services
Type of service accessed
For the children who met DSM-IV criteria for current psychiatric disorder, the types of services that were accessed varied. Teachers and special educational needs (SEN) services were the most frequently accessed services. summarises the frequency of utilisation of each of the services (ever and in the 3 months prior to interview) in those children who had and did not have a psychiatric disorder at the time of interview.
Access to services according to sex and diagnostic group
The pattern of service use varied according to child diagnosis (). Services were more likely to be accessed when children had a mood disorder than when they had anxiety, ADHD, or disruptive behaviour disorders (). For children with anxiety disorder, service use was more frequent among the females than males. No female children with ADHD were in contact with services. Access to services was similar for males and females with mood disorder or disruptive behaviour disorder.
Type of service accessed according to disorder type in the 3 months prior to interview.
Access to services according to child disorder type and sex, in the 3 months prior to interview
Impact of suicidal ideation and self-harm on service use
Of the 333 children included in these analyses, 23 (7.0%) were recorded as having experienced suicidal ideation or self-harm in the 3 months prior to interview. Of these, nine (39.1%) had not accessed services. For those children who had a psychiatric disorder, 15 (19.0%) endorsed suicidal ideation or self-harm symptoms at interview. In total, five (33.3%) of the children who had disorder and suicidal ideation at the time of interview had not accessed any services in the 3 months prior to interview.
Reluctance to ask for help
In total, 15 (19.0%) of parents with children who met criteria for a psychiatric disorder had felt reluctant to ask for help, even though they felt they needed it. Reasons for this included: previous bad experiences (n = 6); worries about stigma (n = 4); fear that it would reflect badly on them as a parent (n = 4); concern about social services getting involved (n = 2); reluctance to admit there was a problem (n = 1); and feeling that they should deal with their own problems first (n = 1). However, reluctance to ask for help was not significantly associated with lack of service use among children with disorder (odds ratio [OR] 1.19, 95% confidence interval [CI] = 0.38 to 3.76, P = 0.769).
Potential barriers to service use
A series of univariate logistic regression analyses investigated factors affecting service use among children with psychiatric disorder (). A number of factors were significantly associated with service use. Children with comorbidity (≥2 disorders) were more likely to access services (OR 5.73, 95% CI = 1.95 to 16.90, P = 0.002) than children with a single disorder. Children in whom suicidality/self-harm had been recorded were also more likely to access services than children without suicidality/self-harm.
Univariate analysis showing potential barriers to services for children with a psychiatric disorder defined by DSM-IV
When looking at potential barriers to service use in children with disorder, lack of parental concern was significantly associated with lack of service use (OR 7.20, 95% CI = 2.36 to 22.01, P = 0.001). Neither features of parental depression (current parental depressive episode, frequent depressive episodes, or presence of a severe depressive episode) nor sociodemographic factors (child age, child sex, age of the affected parent, lone parent family), nor hazardous drinking in the parent significantly affected service use (data available on request).