201 - Socioeconomic Disparities in the Reach of School-Based Universal Mental Health Screening Initiatives

Publication Number: 2193.201

Violet J.. Landrum, Brown University School of Public Health, Providence, RI, United States; Tracy Gladstone, Brown University, Providence, RI, United States; Alix Paredes Molina, Brown University School of Public Health, Providence, RI, United States

Background: Despite the increasing prevalence of adolescent depression, most youth in the United States remain disconnected from mental health services. Integrating universal screening efforts within schools facilitates early identification and referral for students at-risk; however, disparities in school resources may limit their reach. Given that schools are often the first point of access to mental health services, particularly for youth from low-income households, we examined whether screening participation and outcomes differ across school districts serving communities of varying socioeconomic backgrounds.

Objective: To examine whether school district socioeconomic status moderates screening participation and the rate of at-risk identification within a universal school-based depression screening program.

Design/Methods: Our sample included 7th grade students (N=586) from two public school districts participating in a universal screening initiative for depression provided by an outside team. Notably, one district had a higher median household income ($134,591, poverty rate: 5.6%) than the other ($58,614, poverty rate: 19.7%). All students completed the Patient Health Questionniare-Adolescent (PHQ-A), and those with elevated symptoms of depression or other risk indicators (e.g., suicidal ideation) were identified as at-risk and met individually with a clinician. Subsequently, caregivers were contacted to discuss concerns and appropriate recommendations.

Results: In the higher-SES district, 357 of the eligible 381 (91.54%) students were screened, and 229 of the 334 eligible students (68.56%) were screened in the lower-SES district. Relative to students from the higher-SES district, students from the lower-SES district were more likely to be identified as at-risk (29.7% vs. 56.8%, p<.001) and less likely to be connected to mental health services at the time of screening (81% vs. 57.6%, p <.001). Among all screened students, the mean PHQ-A score was higher in the lower-SES district (M=6.02 vs. M=3.00; p<.001). Similarly, the students identified as at-risk reported higher mean PHQ-A scores in the lower-SES district (M=14.01 vs. M = 11.55; p =. 028).

Conclusion(s): Overall, the screening reached fewer students in the lower-SES district, despite identifying a higher proportion of students at-risk. Expanding support for screening implementation and follow-up services in lower-income districts is critical to reduce inequities in early detection and access to care. In order to identify additional barriers to school-based mental health screening, further evaluation of district characteristics is needed.