BACKGROUND In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP) clinics. METHODS The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses. RESULTS Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral. CONCLUSIONS This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach programs and should be considered when developing measures and strategies intended to reach and help children with mental health problems. This might involve providing information about the availability and accessibility of health care for children and adolescents with mental health problems to families in certain neighbourhoods and with different ethnic backgrounds.

中文翻译：

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通往儿童和青少年精神病诊所的途径：种族和社区社会特征对转诊来源意义的多层次研究。

背景在瑞典社会中，与许多其他社会一样，许多有心理健康问题的儿童和青少年没有得到他们需要的帮助。随着瑞典社会变得越来越多元文化，以及种族和经济居住隔离变得更加明显，本研究利用种族和社区背景来检查转诊到儿童和青少年精神病 (CAP) 诊所的途径。方法 该分析检查了四种不同的转介来源：家庭转介、社会/法律机构转介、学校转介和健康/心理健康转介。使用多级逻辑回归分析研究了来自斯德哥尔摩儿童精神病学数据库的 2054 名 11-19 岁儿童的转诊情况。结果 结果表明，种族在如何将儿童和青少年转介到 CAP 诊所方面发挥了重要作用。与有移民背景的儿童和青少年相比，家庭转介在具有瑞典背景的儿童和青少年中更为常见。社会/法律机构的转介在具有非洲和亚洲背景的儿童和青少年中更为常见。具有亚洲或南美背景的儿童更有可能被学校或卫生/心理保健部门转介。在家庭推荐方面发现了显着的邻里效应。与来自其他社区的儿童相比，来自社会经济贫困程度低的社区的儿童和青少年更有可能被家人转介到 CAP 诊所。在与其他转介来源相关的情况下未发现此类差异。结论 本文报告的研究结果可以作为重要的第一步，以加深对不同种族的瑞典样本中不同转诊率和接受精神科护理背后的原因的了解。这些发现对社区心理健康外展计划的设计和评估具有影响，在制定旨在接触和帮助有心理健康问题的儿童的措施和策略时应予以考虑。这可能涉及向某些社区和不同种族背景的家庭提供有关为有心理健康问题的儿童和青少年提供医疗保健服务的信息。结论 本文报告的研究结果可以作为重要的第一步，以加深对不同种族瑞典样本中不同转诊率和接受精神科护理背后的原因的了解。这些发现对社区心理健康外展计划的设计和评估具有影响，在制定旨在接触和帮助有心理健康问题的儿童的措施和策略时应予以考虑。这可能涉及向某些社区和不同种族背景的家庭提供有关为有心理健康问题的儿童和青少年提供医疗保健服务的信息。结论 本文报告的研究结果可以作为重要的第一步，以加深对不同种族瑞典样本中不同转诊率和接受精神科护理背后的原因的了解。这些发现对社区心理健康外展计划的设计和评估具有影响，在制定旨在接触和帮助有心理健康问题的儿童的措施和策略时应予以考虑。这可能涉及向某些社区和不同种族背景的家庭提供有关为有心理健康问题的儿童和青少年提供医疗保健服务的信息。