Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Department of Epidemiology, Columbia University, New York, NY, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 09/2008; 59(8):893-901. DOI: 10.1176/
Source: PubMed


Although studies have shown disparities between black and white populations in service utilization for mental disorders, little information exists on whether such disparities apply equally across disorders. The objective of this study was to examine racial differences in lifetime prevalence of service utilization for mood and anxiety disorders and for alcohol and drug use disorders, with controls for predisposing, enabling, and need-for-service variables unequally distributed between racial-ethnic groups.
Data were from a face-to-face epidemiologic survey of 32,752 non-Hispanic white or black adults ages 18 and older residing in households and group quarters in the United States. Main outcome measures were treatment for mood, anxiety, and alcohol and drug use disorders.
White adults were consistently more likely than black adults to have had treatment for mood disorders (odds ratio [OR]=2.16, 95% confidence interval [CI]=1.80-2.59) and anxiety disorders (OR=1.77, 95% CI=1.43-2.19) after adjustment for predisposing and enabling factors and need for service (severity of disorder). In contrast no evidence of lower service utilization for treatment of alcohol use disorders emerged among black respondents (OR=.87, 95% CI=.69-1.10). Moreover, white respondents with drug use disorders were significantly less likely than black respondents to receive treatment for a drug problem (OR=.64, 95% CI=.47-.88).
Differences in treatment between black and white adults depended on the specific disorder and type of treatment considered. Prevention and intervention strategies should address disorder-specific disparities in services received.


Available from: William Narrow
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    • "For example, individuals with higher education (e.g., high school diploma) are more likely to have received prior treatment (Anglin et al., 1997), especially mental health treatment (Green-Hennessy, 2002; Katz, Kessler, Frank, Leaf, & Lin, 1997). Those who are widowed, separated, divorced, or never married are also more likely to have received prior behavioral health treatment (Anglin et al., 1997; Compton, Thomas, Stinson, & Grant, 2007; Keyes et al., 2008), although one study (Keyes et al., 2008) found that this group was more likely to have received mental health services whereas those who were never married were more likely to have received substance abuse services. "
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    ABSTRACT: This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area. To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out. Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females. Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.
    International Journal for Equity in Health 04/2012; 11(1):20. DOI:10.1186/1475-9276-11-20 · 1.71 Impact Factor
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    • "A well-known framework to examine the use of and access to health care services is Andersen's Behavioural Model, which has been applied in the field of mental health care (see e.g. (Chen & Vargas- Bustamante, 2011; Hatzenbuehler, Keyes, Narrow, Grant, & Hasin, 2008; Keyes et al., 2008). Health care use in this framework is a function of: (a) predisposing factors (such as gender and age); (b) enabling factors (such as income and health insurance status); and (c) perceived and evaluated need (Andersen, 1995, 2008). "
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