Investigating inequalities in children and young people's mental healthcare and outcomes: prospective longitudinal analysis from the STADIA trial.
Kapil Sayal, Grace Holt, Christopher Partlett et al.
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In 30 seconds
This prospective longitudinal analysis of data from the STADIA randomised controlled trial examined access to care and outcomes among 1,225 children aged 5–17 years referred to child and adolescent mental health services in England, followed for 18 months. Older children and those in the least deprived neighbourhoods were more likely to have referrals accepted. At 12 months, 61% met mental health caseness criteria, compared with 67% at baseline; children in less deprived areas had lower odds of meeting caseness criteria than those in the most deprived areas (odds ratio 0.49, 95% CI: 0.30, 0.81).
Key findings
- Each one-year increase in age was associated with higher odds of referral acceptance (odds ratio 1.07, 95% CI: 1.02, 1.11).
- Referral acceptance was more likely in the least versus most deprived neighbourhoods (odds ratio 1.60, 95% CI: 1.05, 2.43).
- At 12 months, 61% met caseness criteria, compared with 67% at baseline; less-deprived neighbourhoods had lower odds of caseness (odds ratio 0.49, 95% CI: 0.30, 0.81).
- Females had higher odds than males of clinically significant depression at 12 months (odds ratio 1.77, 95% CI: 1.28, 2.45).
Why it matters
The findings indicate that access and outcomes may differ by age, sex and neighbourhood deprivation even among children already referred for emotional difficulties. The limited reduction in caseness over the first year also highlights the importance of examining whether services reach younger children and those in more deprived areas, and whether care is associated with meaningful improvement.
What to keep in mind
The analysis concerns children referred to CAMHS in England, so findings may not generalise to children who have not been referred or to other settings. The reported outcomes are observational associations within the trial data and do not establish that access differences caused outcome differences.