When the gatekeeper is also unwell: Parental mental health problems and mental health service use among children with psychiatric diagnoses

Abstract When a parent has mental health problems, does the child’s use of mental health services rise or fall? Two accounts make opposite predictions: a double-burden account, in which parental symptoms deplete the capacity to seek care for the child, and a gateway account, in which the parent’s own experience of distress makes the child’s need easier to recognize and act on. We adjudicated between them using the 2022 Korean National Mental Health Survey of Children and Adolescents, a nationally representative survey of 6,275 parent-child dyads in which caregivers completed standard depression and anxiety screens and each child’s diagnostic status was established by structured interview, independently of parental report. Among 426 children with a current psychiatric diagnosis, lifetime service use was higher, not lower, when the parent was also affected: 30.6% versus 16.1% (adjusted odds ratio 2.21, 95% confidence interval [1.15,4.22]), a difference that held despite greater socioeconomic disadvantage in the both-affected group. Part of the association was carried by the parent’s perceived need for the child’s care (+ 7.6 percentage points, 95% CI [3.3, 14.0]); the direct component was not statistically significant. Yet 69.4% of children in the both-affected group had never used services, and their parents were distinguished not by greater stigma but by the expectation that the problem would resolve without help (71.2% versus 48.3%). Adult mental health services are an underused entry point to children who need care; reaching these families requires addressing minimization, not only awareness.