Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Laura Salazar, PhD

Second Advisor

Ruiyan Luo, PhD


INTRODUCTION: Comorbid depression and substance-use has been a prevalent issue in adolescent health. Although rates have remained relatively stable their presence is still alarming and efforts to see a decrease have led leaders and organizations to call for research to better understand factors related to both depression and substance-use as well as how these factors may change when focusing on the presence of these disorders together.

AIM: The primary aim of this study is to better understand the contextual factors related to mental health care utilization in comorbid adolescents. Specifically focus will be directed to better understand how and individual’s relationship to their school and teachers may relate to mental health care use and whether or not increased school attachment could reduce disparities present in mental health care use.

METHODS: Data from the National Survey on Drug Use and Health (NSDUH) was utilized to test the research objectives for this study. The NSDUH is an on-going cross-sectional survey of the civilian and non- institutionalized population of the United States. In order to address the research aims multi-level logistic regression procedures were used to determine the relationship between mental health care utilization and research measures in adolescents with comorbid depression and substance-use.

RESULTS: Multi-level modeling showed that the model that controlled for individual-level and family-level factors was able to best predict mental health care use (model 4, -2LL=945,303, p > > 0.001). In addition, school attachment was shown to be positively associated with mental health care use in all models tested, including the best-fit model selected (OR=2.18 (95% CI 2.13, 2.22). Other contextual factors that were significantly associated with mental health care use were gender (OR=1.92 (95% CI 1.88, 1.94)), parental attachment (OR=1.72 (95% CI 1.70, 1.74)), and poverty (OR=1.59 (95% CI 1.58, 1.62)). In addition, the school attachment and race/ethnicity interaction term was found to be significant with an odds ratio of 3.02 (95% CI 2.96, 3.22).

DISCUSSION: This research has shown the importance of contextual factors, specifically the school environment, on the service-use of comorbid adolescents. Particularly interesting in the world of mental health prevention is the use of schools as key coordinators in providing specialty mental health services to adolescents who need them especially for those who suffer from service-use disparities.