Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic

Abstract

Purpose: This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization.

Methods: Our retrospective cohort study analyzed adolescents aged 12–17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition, mental health condition, race, sex, and state of residence.

Results: Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year; however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19. Higher odds of using MHS was associated with chronic medical condition and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% during the COVID-19 pandemic.

Discussion: Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.