Racial disparities in adolescent mental health services remain an unrelenting public health problem. The purpose of this study was to understand the differential system of care service utilization patterns and associated symptoms among African American and Caucasian adolescents with serious emotional disturbances (N = 655; M age = 13.7, 60% Caucasian, 63% male). The primary objectives were to: (1) explore differences in perceptions of mental health service experiences at 6-months by race; (2) examine race as a moderator between perceptions of service experiences and receipt of services between 6 and 12 months; and (3) explore mental health symptoms at 12 months as a function of race. Mental health symptoms for a subsample of youth (N = 548) with elevated symptoms were also examined. A secondary data analysis using data from the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHI) and generalized estimating equation (GEE) analyses indicated that (1) African American and Caucasian adolescents did not differ in their overall perceptions of their service experience, (2) race did not moderate perceptions and receipt of services, and (3) race moderated the relationship between receipt of family therapy and externalizing symptoms. The results also showed that use of individual therapy was predicted by race (Caucasian) and greater emotional/behavioral symptoms at baseline, while group therapy was predicated by gender (male) and greater functional impairment at baseline. Adolescents' perceived social support from adults (not peers) predicted fewer internalizing symptoms, and Caucasian adolescents experienced fewer externalizing symptoms. The examination of mental health symptoms for the subsample revealed that race did not moderate receipt of services and symptoms. Instead, perceived social support from adults (not peers) predicted fewer internalizing symptoms, and clinician-client racial match predicted fewer externalizing symptoms. The findings suggest that African American and Caucasian adolescents share similar perceptions of their service experience, yet disparities in service use and symptomatology persist. Further, youth with perceived social support and a clinician-client racial match experience fewer mental health symptoms. Practitioners should assess adolescent's perceived social support upon receipt of treatment, discuss clinician preferences, and explore opportunities to engage African American families in family therapy.

Anxiety disorders are a common and can cause significant impairment in an adolescent's life (Last et al., 1997). Psychosocial treatments, particularly cognitive behavioral therapy, are effective in treating anxiety disorders, but there are many adolescents who have participated in empirically-based psychosocial treatment approaches who are still not improving (Bernstein & Kinlan, 1997; In-Albon & Schneider, 2004). The tripartite model of anxiety and depression was developed to try to account for the high comorbidity between anxiety and depression. The models states that there is a common component to anxiety and depression, which is negative affectivity, and unique components to anxiety, physiological arousal, and depression, low positive affectivity or anhendonia. The purpose of this dissertation study was to increase the knowledge base on the phenomenology of anxiety disorders. The objectives were to: (1) examine gender and ethnic differences in positive and negative affectivity and depressive and anxiety symptomology; and (2) to clarify the relationship between anxiety and the components of anxiety sensitivity within the tripartite model of anxiety and depression. This study consisted of mailed survey to a simple random sample of 315 adolescents between the ages of 12 and 18 who were in treatment for an anxiety and/or depressive disorder. A total of 187 completed surveys were returned for a 61.1% response rate. Adolescents filled out the Positive and Negative Affectivity Scale, Childhood Anxiety Sensitivity Index, and the Revised Child Anxiety and Depression Scale. There was not a statistically significant difference found between the ethnic subgroups (i.e., Hispanic/Latino or any ethnic subgroup) and the Caucasian subgroup on positive and negative affectivity and anxiety and depression. There was also no statistically significant difference found between males and females on negative and positive affectivity and anxiety and depression. A modified tripartite model of anxiety and depression fit the data the best with negative affectivity being related to anxiety and depression, low positive affectivity being related to depression, and physiological arousal being related to anxiety, and anxiety being related to depression. Another modified tripartite model, which examined the specific components of anxiety sensitivity related to specific anxiety disorders, did not fit the data as well as the earlier model. This study did find difference between ethnic subgroups and Caucasian adolescents or between males and females, which suggests there are more similarities than difference between these various subgroups. Additionally, the modified tripartite model supported the role of negative affectivity being related to anxiety and depression and there are unique components, physiological arousal and anhendonia, related to anxiety and depression. This study uniquely found that anxiety was related to depression, suggesting a mixed anxiety and depressive state.