Adolescent mental health and utilisation of psychiatric care : the role of parental country of birth and neighbourhood of residence

The studies included in this thesis aim to illustrate different aspects of mental health and the utilisation of psychiatric care among Swedish children and adolescents, with the overarching aim being to improve the existing knowledge on how the neighbourhood of residence and parental country of birth influence adolescents’ mental health and their pathways into and utilisation of psychiatric care. The first study investigates referral pathways to child and adolescent psychiatric clinics, directing a special focus at how these pathways differ on the basis of parental country of birth and neighbourhood of residence. The results show that parental country of birth plays an important role in how children and adolescents are referred to the child and adolescent psychiatric sector. Children and adolescents with Swedish-born parents appear more often to have been referred by their families, whereas by comparison with children and adolescents with Swedish-born parents, those with foreign-born parents had more often than been referred by someone outside the family, such as the social services or their school. Neighbourhood of residence was found to play a significant role in relation to family referrals; children and adolescents living in neighbourhoods with low levels of socioeconomic deprivation were more likely to have been referred by their families by comparison with those from more deprived neighbourhoods. The second study investigates how parental country of birth and individual gender are associated with the utilisation of psychiatric care. The findings from the study indicate that adolescents whose parents were born in middleor low-income countries present lower levels of psychiatric outpatient care utilisation than those with Swedish-born parents. Initially, no associations 7 were found between parental country of birth and inpatient care. Following adjustment for socio-demographic variables, it was found that adolescents whose parents were born in low-income countries were also less likely to utilise inpatient care. Girls were more likely to have utilised psychiatric care, but controlling for possible interactions revealed that this was true primarily for girls with parents born in Sweden or other high-income countries. In the third study, psychiatric care utilisation patterns are analysed in relation to the neighbourhood of residence. In part the aim was to investigate the validity of the neighbourhood when it comes to understanding variations in adolescents’ utilisation of psychiatric care, but the study also examines whether neighbourhood socioeconomic deprivation is associated with individual variations in the utilisation of psychiatric care. The results indicate that the neighbourhood of residence has little influence on the utilisation of psychiatric care, only 1.6 % of the variance was found at the neighbourhood level. No clear association between the neighbourhood level of socioeconomic deprivation and levels of psychiatric care utilisation was found in the study. The final study investigates how adolescents’ perceptions of the social characteristics of their neighbourhood are related to their self-reported mental health, while controlling for the socioeconomic structure of the neighbourhood. The results show that adolescents’ perceptions of their neighbourhood are associated with their self-reported mental health, particularly their perceptions of social disorder. However, these associations differ between girls and boys, and between adolescents with Swedish- and foreign-born parents. In conclusion, the results presented in the thesis show that parental country of birth is an important factor when it comes to understanding differences in referral patterns and in the utilisation of psychiatric care. However, the role of the neighbourhood of residence appears to be more complex