OBJECTIVES: Shared decision making (SDM) is important in children with mental health conditions because of multiple evidence-based options and variability in acceptance and adherence of these options by families. The objective was to identify patterns of SDM among children and adolescents with mental health conditions, and determine the factors associated with SDM.

METHODS: This study involved use of 2010-2014 Medical Expenditure Panel Surveys (MEPS), a nationally representative sample of the non-institutionalized US population. The study sample included children and adolescents (age ≤ 17 years) with a diagnosis of highly prevalent mental health conditions, namely Attention-Deficit/Hyperactivity Disorder, conduct disorders, mood disorders, and anxiety. Latent Class Analysis (LCA) was used to identify patterns of SDM by the families based on seven MEPS items that reflects concepts of SDM like involvement, information sharing, respecting, listening, and agreement. Multinomial logistic regression model was performed to determine the factors associated with patterns of SDM in children with mental health conditions.

RESULTS: In the MEPS, there were an estimated 6 million children annually with mental health conditions. LCA identified four classes of SDM based on the seven items; very high (59.8%), high (16.7%), medium (5.0%), and low (18.5%) SDM. Relative to low SDM, households with anxiety children were less likely to have very high (OR=0.88, 95% CI=0.78-0.99) SDM and households with mood/conduct disorder children are more likely to have high (OR=2.29, 95% CI=1.52-3.46) SDM. The other significant factors in SDM were race, general and mental health status, federal poverty level, and insurance.

CONCLUSIONS: The study found that majority of families involving children with mental health conditions had high or very high SDM and various mental health conditions and sociodemographic factors influenced families’ participation in SDM. Additional work is needed to identify modifiable risk factors to better engage families in SDM for children with mental health conditions.