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 mentalhealth and the utilisation of psychiatric care among Swedish children andadolescents, with the overarching aim being to improve the existingknowledge on how the neighbourhood of residence and parental country ofbirth influence adolescents’ mental health and their pathways into andutilisation of psychiatric care.The first study investigates referral pathways to child and adolescentpsychiatric clinics, directing a special focus at how these pathways differ onthe basis of parental country of birth and neighbourhood of residence. Theresults show that parental country of birth plays an important role in howchildren and adolescents are referred to the child and adolescent psychiatricsector. Children and adolescents with Swedish-born parents appear more oftento have been referred by their families, whereas by comparison with childrenand adolescents with Swedish-born parents, those with foreign-born parentshad more often than been referred by someone outside the family, such as thesocial services or their school. Neighbourhood of residence was found to playa significant role in relation to family referrals; children and adolescents livingin neighbourhoods with low levels of socioeconomic deprivation were morelikely to have been referred by their families by comparison with those frommore deprived neighbourhoods.The second study investigates how parental country of birth and individualgender are associated with the utilisation of psychiatric care. The findingsfrom the study indicate that adolescents whose parents were born in middleorlow-income countries present lower levels of psychiatric outpatient careutilisation than those with Swedish-born parents. Initially, no associations7were found between parental country of birth and inpatient care. Followingadjustment for socio-demographic variables, it was found that adolescentswhose parents were born in low-income countries were also less likely toutilise inpatient care. Girls were more likely to have utilised psychiatric care,but controlling for possible interactions revealed that this was true primarilyfor girls with parents born in Sweden or other high-income countries.In the third study, psychiatric care utilisation patterns are analysed in relationto the neighbourhood of residence. In part the aim was to investigate thevalidity of the neighbourhood when it comes to understanding variations inadolescents’ utilisation of psychiatric care, but the study also examineswhether neighbourhood socioeconomic deprivation is associated withindividual variations in the utilisation of psychiatric care. The results indicatethat the neighbourhood of residence has little influence on the utilisation ofpsychiatric care, only 1.6 % of the variance was found at the neighbourhoodlevel. No clear association between the neighbourhood level of socioeconomicdeprivation and levels of psychiatric care utilisation was found in the study.The final study investigates how adolescents’ perceptions of the socialcharacteristics of their neighbourhood are related to their self-reported mentalhealth, while controlling for the socioeconomic structure of theneighbourhood. The results show that adolescents’ perceptions of theirneighbourhood are associated with their self-reported mental health,particularly their perceptions of social disorder. However, these associationsdiffer between girls and boys, and between adolescents with Swedish- andforeign-born parents.In conclusion, the results presented in the thesis show that parental country ofbirth is an important factor when it comes to understanding differences inreferral patterns and in the utilisation of psychiatric care. However, the role ofthe neighbourhood of residence appears to be more complex