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. 2025 Mar;25(2):102585.
doi: 10.1016/j.acap.2024.09.009. Epub 2024 Oct 1.

State Differences in Children's Mental Health Care

Genevieve Graaf  1 , Phillip M Hughes  2 , Kristin H Gigli  3 , Neal A deJong  4 , Robert E McGrath  5 , Kathleen C Thomas  6
Affiliations

State Differences in Children's Mental Health Care

Genevieve Graaf et al. Acad Pediatr. 2025 Mar.

Abstract

Objective: This study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial and ethnic group, household income, and insurance type.

Methods: Using a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children's Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation.

Results: Adjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states' probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups.

Conclusions: Geographic inequities in children's mental health care access persist; in some cases, they are larger than sociodemographic inequities.

Keywords: access to mental health care; child mental health; geographic disparities; unmet mental health care need.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Genevieve Graaf reports financial support was provided by National Institute of Mental Health. Phillip Hughes reports financial support was provided by Agency for Healthcare Research and Quality.

Figures

Figure 1.
Figure 1.. Probabilities of Children with Caregiver-Reported Child Unmet Mental Health Need, and Difficulty Accessing Mental Health Care
Adjusted Models include caregiver education level, family structure, household language, level of child impairment, gaps in insurance, and year. Point estimates include indicators (lines on either side of point) for 95% confidence intervals; Data Source: National Survey of Children’s Health, 2016–2019; Proportions are weighted to be nationally and state representative; Appendix H, I, and J provide state predicted probabilities and their difference from the national predicted probability. Appendix F and G provide adjusted and unadjusted odds ratios for strata and covariates. a Among children with parent reported mental health problems and need for mental health care; * significant at p<.05; ** significant at p<.01; *** significant at p<.001;
Figure 2.
Figure 2.. Box and Whisker Plots of Probabilities of Caregiver-Reported Child Unmet Mental Health Need and Difficulty Accessing Mental Health Care: Comparing State, Socioeconomic and Demographic Subgroups
Adjusted Models include caregiver education level, family structure, household language, level of child impairment, gaps in insurance, and year Data Source: National Survey of Children’s Health, 2016–2019 Proportions are weighted to be nationally and state representative; Appendix H, I, and J provide state predicted probabilities and their difference from the national predicted probability. Appendix F and G provide adjusted and unadjusted odds ratios for strata and covariates.a Among children with parent reported mental health problems and need for mental health care
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