15581-m-nanninga

DETERMINANTS - SYSTEMATIC REVIEW 81 DISCUSSION Our systematic review of the literature on the determinants of enrolment in and use of psychosocial care by children and adolescents resulted in 22 relevant studies of high quality. Results showed that many child and family characteristics were associated with enrolment in and use of psychosocial care. The main identified child determinants were psychosocial problems, urban area residence, life events, academic problems, and past treatment. For age, gender, ethnicity, and place of residence, varying effects were found. The main identified family determinants were living in another than a biological two-parent family, and SES (varying effects). Interpretation and comparison with earlier reviews To our knowledge, this review is the first providing a very broad overview of studies on determinants of both enrolment in and use of a broad field of psychosocial care for both children and adolescents. We encountered large differences between the included studies. Differences existed not only within countries and care systems, but also in study designs, study populations, children’s age ranges and measures of both outcomes and determinants. Regarding the results on determinants for which varying effects were found, this heterogeneity could be partly due to different effects of these characteristics on different stages of passing the care system, because of setting-specific factors. For example, regarding place of residence, children living at home were more likely to be admitted to inpatient care compared to children in non-kinship foster care [29], whereas these children were less likely to use care compared to children placed out of home – that is, living in (non-)kinship foster care or in group homes and residential care– [32, 40]. Regarding gender, the varying effect might be due to the type of psychosocial problems, i.e. the study showing a higher likelihood of using care for girls was among those who attempted suicide [41], whereas the studies showing a higher likelihood for boys were among children with psychosocial problems and among the general child population [26, 33, 35, 42, 44]. The effect of age varied across filters as well. Problem recognition was highest in children of primary school age [6, 7], whereas admittance to inpatient care and use of care were mostly more likely in older children [29, 33, 38-40]. Possible explanations may be that passing through the system takes time, causing mean age to increase at higher filters, or a reluctance to start the most specialized care for very young children. Regarding ethnicity, enrolment in and use of care were more likely for white/Caucasian children in U.S. studies [26, 31, 32, 34-41, 43, 44] and also in one Dutch study [42], whereas in another Dutch study non-Caucasian adolescents or adolescents