The role of parental burden in child mental health service use: longitudinal study

OBJECTIVE: To examine the relative contributions of symptom severity, functional impairment, and parental burden in predicting the use of specialist child mental health services over a 4-year period. METHOD: Between 1999 and 2000, parental Strengths and Difficulties Questionnaires were completed on a community-based sample of 1,168 (40% response rate) 5- to 11-year-olds in the United Kingdom. Using a prospective longitudinal design, these data were related to subsequent referral records (until 2003). Children who were and were not referred to specialist mental health services were compared. Changes in the association between predictor variables (symptoms, impairment, and burden) and referral over time were also examined. RESULTS: Over 4 years, 5.1% of children were referred. After controlling for all other predictors, only severity of symptoms predicted future referrals (for each 1-point increase on the total symptoms score, odds ratio 1.15; 95% confidence interval=1.09-1.21). Burden was only associated with referrals made during the first year, whereas conduct and emotional problems predicted subsequent referrals. CONCLUSIONS: In contrast to cross-sectional studies that have highlighted the roles of functional impairment and parental burden in predicting specialist service use, this longitudinal study indicates that symptom severity best predicts future referrals. For children with mental health problems, there is considerable delay in accessing specialist services.