■许多患有精神和行为健康(MBH)疾病的美国儿童和青少年无法获得MBH服务。一个促成因素是有限的保险范围,这受到州MBH保险平价立法的影响。
■调查患者水平因素和州MBH保险立法的全面性与美国儿童和青少年获得MBH护理的机会不足和MBH保险覆盖面不足的关系。
■这项回顾性横断面研究是使用2016年至2019年全国儿童健康和州精神健康保险法调查中6至17岁患有MBH疾病的儿童和青少年的照顾者的反应进行的。数据分析于2022年5月至2024年1月进行。
■国家精神健康保险法数据集(SMHILD)分数(范围,0-7)。
■评估了MBH护理的不良获取和MBH保险的不足。针对个体水平特征进行调整的多变量回归模型。
■在研究期间,有29876名患有MBH疾病的儿童和青少年照顾者,全国有14292300名青年(7816727名12-17岁[54.7%];8455171名男性[59.2%];292543名亚洲人[2.0%],2076442黑色[14.5%],和9942088白人[69.6%];3202525西班牙裔[22.4%])。共有3193名护理人员,代表1770492名儿童和青少年(12.4%),他们认为获得MBH护理的机会不足,和代表13175295名儿童和青少年中的1643260名(12.5%)的3517名护理人员认为MBH保险范围不足。在多变量模型中,在Black的照顾者中,感知到MBH护理不良的几率更高(调整后的优势比[aOR],1.35;95%CI,1.04-1.75)和亚洲(aOR,1.69;95%CI,1.01-2.84)与白人儿童和青少年相比。随着不良童年经历(ACE)暴露的增加,被认为无法获得MBH护理的几率增加(aOR范围为1.68;95%,1次ACE至4.28的CI1.32-2.13;≥4次ACE与无ACE相比,95%CI为3.17-5.77)。与生活在MBH保险立法最不全面的州相比(SMHILD评分,0-2),生活在立法最全面的州(SMHILD得分,5-7)与感知到MBH护理不良的几率较低相关(aOR,0.79;95%CI,0.63-0.99),而生活在立法较为全面的州(分数,4)与感知MBH保险覆盖范围不足的较高几率相关(AOR,1.23;95%CI,1.01-1.49)。
■在这项研究中,对于患有MBH疾病的儿童和青少年,生活在MBH保险立法最全面的州,与看护者认为无法获得MBH护理的几率较低相关.这一发现表明,倡导全面的心理健康均等立法可能会促进儿童和青少年更好地获得MBH服务。
UNASSIGNED: Many US children and adolescents with mental and behavioral health (MBH) conditions do not access MBH services. One contributing factor is limited insurance coverage, which is influenced by state MBH insurance parity legislation.
UNASSIGNED: To investigate the association of patient-level factors and the comprehensiveness of state MBH insurance legislation with perceived poor access to MBH care and perceived inadequate MBH insurance coverage for US children and adolescents.
UNASSIGNED: This retrospective cross-sectional study was conducted using responses by caregivers of children and adolescents aged 6 to 17 years with MBH conditions in the National Survey of Children\'s Health and State Mental Health Insurance Laws Dataset from 2016 to 2019. Data analyses were conducted from May 2022 to January 2024.
UNASSIGNED: MBH insurance legislation comprehensiveness defined by State Mental Health Insurance Laws Dataset (SMHILD) scores (range, 0-7).
UNASSIGNED: Perceived poor access to MBH care and perceived inadequacy of MBH insurance were assessed. Multivariable regression models adjusted for individual-level characteristics.
UNASSIGNED: There were 29 876 caregivers of children and adolescents with MBH conditions during the study period representing 14 292 300 youths nationally (7 816 727 aged 12-17 years [54.7%]; 8 455 171 male [59.2%]; 292 543 Asian [2.0%], 2 076 442 Black [14.5%], and 9 942 088 White [69.6%%]; 3 202 525 Hispanic [22.4%]). A total of 3193 caregivers representing 1 770 492 children and adolescents (12.4%) perceived poor access to MBH care, and 3517 caregivers representing 1 643 260 of 13 175 295 children and adolescents (12.5%) perceived inadequate MBH insurance coverage. In multivariable models, there were higher odds of perceived poor access to MBH care among caregivers of Black (adjusted odds ratio [aOR], 1.35; 95% CI, 1.04-1.75) and Asian (aOR, 1.69; 95% CI, 1.01-2.84) compared with White children and adolescents. As exposures to adverse childhood experiences (ACEs) increased, the odds of perceived poor access to MBH care increased (aORs ranged from 1.68; 95%, CI 1.32-2.13 for 1 ACE to 4.28; 95% CI, 3.17-5.77 for ≥4 ACEs compared with no ACEs). Compared with living in states with the least comprehensive MBH insurance legislation (SMHILD score, 0-2), living in states with the most comprehensive legislation (SMHILD score, 5-7) was associated with lower odds of perceived poor access to MBH care (aOR, 0.79; 95% CI, 0.63-0.99), while living in states with moderately comprehensive legislation (score, 4) was associated with higher odds of perceived inadequate MBH insurance coverage (aOR, 1.23; 95% CI, 1.01-1.49).
UNASSIGNED: In this study, living in states with the most comprehensive MBH insurance legislation was associated with lower odds of perceived poor access to MBH care among caregivers for children and adolescents with MBH conditions. This finding suggests that advocacy for comprehensive mental health parity legislation may promote improved child and adolescent access to MBH services.