Anxiety and depression in youth are prevalent, yet few affected youths receive an adequate dose of mental health treatment (MHT). Parents’ perceptions of barriers to treatment participation may be critical, as parents serve as gatekeepers to services. Providing MHT in high-access settings like pediatric primary care may reduce barriers and increase access to adequate care.
Parents’ perceptions of barriers were examined in an RCT (n = 185) investigating the effectiveness of primary-care-embedded Brief Behavioral Therapy (BBT) for anxious and/or depressed youths (ages 8-16) versus assisted referral to care (ARC) in traditional outpatient settings. Aims included identifying family characteristics associated with anticipated barriers (A-BTP; Aim 1) at baseline and experienced barriers (E-BTP; Aim 2) measured at Week 16 after treatment engagement and testing if E-BTP mediated the effects of treatment assignment on receipt of an adequate dose (≥ 8 sessions; Aim 3). It was hypothesized that psychopathology and marginalization would be associated with higher barriers, BBT assignment and lower E-BTP associated with adequate dose, and that associations between A-BTP and E-BTP would be weaker in BBT.
As hypothesized, higher A-BTP was associated with higher parent anxiety and depression at baseline; however, lower youth depression was also associated with higher A-BTP. Higher A-BTP, youth Latinx identity, poorer youth functioning, higher parent anxiety, and older parent age at baseline were associated with higher E-BTP. Associations between A-BTP and E-BTP were weaker in BBT versus ARC (interaction β = -0.27, p = .020). Assignment to BBT (OR = 22.42, p = .039, 95% CI = 9.06-55.50) was associated with adequate dose. However, contrary to hypotheses, treatment assignment was not related to E-BTP, and models including E-BTP, treatment, and dose were unstable and could not be estimated.
In this sample of anxious/depressed youths, parents’ perceptions of barriers were associated with psychopathology and Latinx identity. Anticipated (A-BTP) and experienced barriers (E-BTP) were associated, and assignment to primary care-based BBT was more likely to result in an adequate dose. Families with Latinx youth, elevated parent psychopathology, and poorer youth functioning are more likely to perceive barriers to treatment and may need additional support to facilitate treatment participation.
