Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury

J Head Trauma Rehabil. May/Jun 2018;33(3):177-184. doi: 10.1097/HTR.0000000000000348.


Objective: To examine racial differences in mental health service utilization after hospitalization for traumatic brain injury (TBI) among children with Medicaid insurance.

Design and main measures: Retrospective analysis of the MarketScan Multi-State Medicaid database from 2007 to 2012 was performed. Outpatient mental health service utilization (psychiatric and psychological individual and group services) was compared at TBI hospitalization, from discharge to 3 months and from 4 to 12 months after discharge, between children of non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and "Other" racial groups. Multivariable mixed-effects Poisson regression models with robust standard errors were utilized.

Results: A total of 5674 children (aged <21 years) were included in the study. There were no differences by race/ethnicity in mental health service utilization during hospitalization. At 3 months postdischarge, NHB children and children in the "Other" racial category were significantly less likely to receive outpatient mental health services than NHW children (NHB relative risk [RR] = 0.84; 95% confidence interval [CI], 0.72-0.98; Other RR = 0.72; 95% CI, 0.57-0.90). At 12 months, all racial minority children were significantly less likely to receive outpatient mental health services than NHW children (NHB RR = 0.84; 95% CI, 0.75-0.94; Hispanic RR = 0.72; 95% CI, 0.55-0.94; Other RR = 0.71; 95% CI, 0.60-0.84).

Conclusions: Racial disparities in utilization of outpatient mental health services exist for minority children hospitalized for TBI and insured by Medicaid. Future research should focus on improving transitions of care from inpatient to outpatient services for these children.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • African Americans / statistics & numerical data
  • Ambulatory Care / statistics & numerical data*
  • Brain Injuries, Traumatic / diagnosis
  • Brain Injuries, Traumatic / epidemiology
  • Brain Injuries, Traumatic / therapy*
  • Child
  • Child, Preschool
  • Cohort Studies
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Healthcare Disparities / ethnology*
  • Hispanic Americans / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medicaid / economics
  • Mental Health / ethnology
  • Mental Health Services / statistics & numerical data*
  • Needs Assessment
  • Outcome Assessment, Health Care*
  • Outpatients / statistics & numerical data
  • Patient Transfer / methods*
  • Racism / statistics & numerical data
  • Retrospective Studies
  • Risk Assessment
  • Socioeconomic Factors
  • United States