Longitudinal Determinants of School-Based Mental Health Service Use for Girls and Boys with Externalizing Behavior Problems
Verlaan P, Déry M, Temcheff CE, Toupin J. (2018). Longitudinal Determinants of School-Based Mental Health Service Use for Girls and Boys with Externalizing Behavior Problems. School Mental Health. 10(3): 322-337.
Studies suggest that girls with externalizing problems (ExtP) who receive school-based mental health services may have more severe impairments than boys. In addition, girls with ExtP who receive mental health treatments have been found do so for shorter durations, but this remains to be confirmed among children receiving school-based mental health services. This study sought to (1) examine gender differences in students’ characteristics and problem severity at study inception and in mental health service use at school at 12-, 24- and 36-month follow-up and (2) investigate longitudinal child, family and school determinants of service use among girls and boys. Participants were 370 elementary school students (149 girls) receiving school-based mental health services for ExtP. Child, family and school determinants of mental health services at school were examined ecologically from parent and teacher reports at study inception and follow-up points. Proportionally more girls than boys presented clinical ExtP and fewer retained services at each follow-up point. Multilevel generalized estimating equations models indicated that, among girls, conflict with teacher, affiliation with deviant peers and poor academic functioning significantly increased the likelihood of mental health service use over time but that ExtP severity was the most robust independent predictor. A broader set of determinants emerged for boys, including ExtP severity, internalizing problems and affiliation with deviant peers. These results suggest that adults may be more sensitive to boys’ difficulties than to girls’ and that girls who receive school mental health services typically present more severe impairments.