Mental health service use among adolescents in three low- and middle-income countries: An analysis of the National Adolescent Mental Health Surveys.

Background: Mental disorders are prevalent and their onset is highest during adolescence. However, there are limited data on adolescent mental health service utilization in low- and middle-income countries.

Methods: Data were from the National Adolescent Mental Health Surveys (NAMHS), nationally representative household surveys of adolescents aged 10-17 years and their primary caregiver conducted in Kenya, Indonesia, and Vietnam. All primary caregivers were asked whether their adolescent used any services providing support or counselling for emotional or behavioural problems in the past 12 months. Mental disorders were assessed using the Diagnostic Interview Schedule for Children, Version 5 (DISC-5). The prevalence of service use was calculated among those with mental disorders, subthreshold mental disorders, and no mental disorder. The prevalence of service use among those with either a diagnostic or subthreshold mental disorder was compared by demographic characteristics and broad mental disorder type. All estimates were weighted using population weights for each country and presented with 95% confidence intervals (CI).

Results: Very few adolescents with a mental disorder (Kenya: 11.9%, 95% CI: 9.3-15.1; Indonesia: 4.7%, 95% CI: 1.9-11.1; Vietnam: 8.2%; 95% CI: 3.9-16.4) or a subthreshold mental disorder (Kenya: 10.8%, 95% CI: 9.1-12.9; Indonesia: 2.2%, 95% CI: 1.1-4.5; Vietnam: 8.5%; 95% CI: 5.0-14.1) accessed services that provide support or counselling for emotional or behavioural problems in the past 12 months. In Kenya, being older (aOR 1.41, 95% CI; 1.07-1.86) and female (aOR 1.77, 95% CI; 1.34-2.34) were associated with increased odds of service use, while having internalising disorders only (aOR 0.45, 95% CI; 0.30-0.65) was associated with decreased odds of service use. No difference by demographic characteristics or mental disorder type was seen in Indonesia and Vietnam.

Conclusions: Only a small proportion of adolescents with a diagnostic or subthreshold mental disorder accessed services for mental health in Kenya, Indonesia, and Vietnam. These findings indicate the need for greater support for adolescents with mental disorders and provide critical context for governments and relevant in-country stakeholders when reviewing the availability and accessibility of adolescent mental health services.