Access Type

Open Access Thesis

Date of Award

January 2017

Degree Type


Degree Name




First Advisor

Douglas Barnett


Adolescence has been described as “a time of storm and stress” (Arnett, 1999; Hall, 1904). In fact, a national survey in the United States estimated that adolescents were twice as likely than adults to report at least one major depressive episode in the past 12 months (Center for Behavioral Health Statistics and Quality, 2016). In particular, adolescents who are poor, who belong to ethnic minority groups, and who live in urban neighborhoods are more vulnerable to mood and behavioral symptoms than their White/Caucasian counterparts who grow up in relatively affluent suburban and rural areas (Beyers, Bates, Pettit, & Dodge, 2003; McLaughlin, Hilt, & Nolen-Hoeksema, 2007; Slopen, Fitzmaurice, Williams, & Gilman, 2010). In the United States, estimates are that half of all adolescents with mental health problems do not seek or obtain mental health treatment (Costello, He, Sampson, Kessler, & Merikangas, 2014). This discrepancy between mental health need and service utilization appears to be especially prevalent among African American youth, who are half as likely to receive mental health services than non-Hispanic white youth (Garland et al., 2005). To create effective, available, and attractive interventions that bridge the gap between mental health needs and service utilization, it may prove helpful to investigate the factors that are positively and negatively associated with mental health service utilization among youth that are residing in high risk urban communities. Researchers have identified the recognition of mental health problems by youth and parents and the perceived costs and benefits of mental health care to parents as two influential factors in predicting help seeking tendency (Eiraldi, Mazzuca, Clarke, & Power, 2006). Although some preliminary research effort has identified factors influencing help seeking behavior, little is known about the collective effects of such factors and their specific ramifications in predicting mental health service utilization. The current study utilized Structural Equation Modeling (SEM) to examine the complex effects of multiple variables simultaneously. Results showed that the majority of adolescents (63.6%) with clinically significant behavioral problems did not reported current mental health service utilization. There is evidence that caregiver’s perceived needs for mental health care and their attitudes towards professional help are associated with higher likelihood of service utilization among adolescents. Youth’s attitudes did not matter in regard to actual service enrollment. Furthermore, social stigma and self-stigma did not contribute meaningfully to the models. In other words, caregivers of urban at-risk adolescents may have the ultimate determining power in mental health care involvement and their decisions may not be influenced directly by stigma. Additional, caregiver’s perceived mental health need fully mediated the relation between spirituality/religiosity (i.e., existential well-being) and service utilization. Youth’s spirituality/religiosity, specifically existential well-being, appears to protect them from mental health problems and in turn associate with lower likelihood of service utilization. Implications about adolescent’s mental health care decision were discussed.