National Trends in Ethnic Disparities in Mental Health Care
Departments of Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Medical Care
(Impact Factor: 3.23).
12/2007; 45(11):1012-9. DOI: 10.1097/MLR.0b013e3180ca95d3
To compare trends in office-based treatment of mental disorders between Hispanics and non-Hispanics.
Analysis of a nationally representative sample of visits to office-based physicians conducted between 1993 and 2002 (N = 251,905). Visits were grouped into 3 discrete time periods, 1993-1996, 1997-1999 and 2000-2002.
Rate of diagnosis, type of mental health visit, type of treatment received (medication or psychotherapy), rate of psychotropic medications prescription, and specialty of the treating physician.
From 1993-1996 to 2000-2002, the proportion of office visits in which mental health care was provided decreased for Hispanics from 12.2% to 11.7% while it increased from 13.1% to 15.7% for non-Hispanics (P < 0.05). Visits with a diagnosis of mental disorder decreased from 5.2% to 5.1% in Hispanics but increased from 6.0% to 8.8% in non-Hispanics (P < 0.05). Visits resulting in prescription of a psychotropic medication decreased from 10.2% to 9.3% in Hispanics, while they increased from 10.2% to 12.5% in non-Hispanics (P < 0.05). Psychotherapy visits decreased from 2.4% to 1.3% in Hispanics (P < 0.05), whereas they remained constant (2.5%) in non-Hispanics. Visits to a psychiatrist decreased from 2.5% to 1.3% in Hispanics (P < 0.05), while they increased (nonsignificantly) from 3.1% to 3.5% for non-Hispanics. Most differences persisted after adjusting for age and insurance status.
From 1993 to 2002, there was an increase in mental health care disparities between Hispanics and non-Hispanics treated by office-based physicians. Improvement of the mental health care for Hispanics continues to be an important public health priority, with clear opportunities and challenges for health care policy-makers and practitioners.
Available from: Steven Applewhite
- "mental illness, tend not to access or utilize mental health services available to them (Alegria et al., 2008a; Blanco et al., 2007; Cook, McGuire, & Miranda, 2007). Alegria et al. (2002) examined disparities in utilization rates of specialty mental health care, defined as treatment by a mental health professional such as a psychiatrist, psychologist, or psychotherapist in a specialty mental health setting, and found that a significantly higher proportion of non-Latinos "
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Cultural and structural barriers have resulted in lower mental health service use by Latinos. In the interest of greater access to mental health care for older Mexican Americans, this qualitative study explored the factors that led 20 older Mexican Americans to access mental health services. Factors included family and helping professionals. The overarching themes were culturally responsive agencies and sustained relationships as pathways to service utilization characterized as professional, as well as close and family-like interactions. Family members and health care providers facilitated utilization. Expanding the workforce of bilingual/bicultural providers and community education about the importance of relationships in mental health care are needed.
Social Work in Mental Health 06/2015; Volume 13(Issue 4):390-414. DOI:10.1080/15332985.2014.927813
Available from: Laura MacPherson
- "Although MDD is generally highly treatable, many barriers preclude Latinos with LEP from accessing quality mental health care [12,13]. In general, less than 5% of Latino immigrants afflicted with psychological disorders seek mental health services from specialized practitioners  due to a combination of linguistic and economic barriers, cultural stigma, and the lack of empirically supported treatments for this population [13-15]. "
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Major depressive disorder is highly prevalent among Latinos with limited English language proficiency in the United States. Although major depressive disorder is highly treatable, barriers to depression treatment have historically prevented Latinos with limited English language proficiency from accessing effective interventions. The project seeks to evaluate the efficacy of behavioral activation treatment for depression, an empirically supported treatment for depression, as an intervention that may address some of the disparities surrounding the receipt of efficacious mental health care for this population.
Following a pilot study of behavioral activation treatment for depression with 10 participants which yielded very promising results, the current study is a randomized control trial testing behavioral activation treatment for depression versus a supportive counseling treatment for depression. We are in the process of recruiting 60 Latinos with limited English language proficiency meeting criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th and 5th Edition for participation in a single-center efficacy trial. Participants are randomized to receive 10 sessions of behavioral activation treatment for depression (n = 30) or 10 sessions of supportive counseling (n = 30). Assessments occur prior to each session and at 1 month after completing treatment. Intervention targets include depressive symptomatology and the proposed mechanisms of behavioral activation treatment for depression: activity level and environmental reward. We will also examine other factors related to treatment outcome such as treatment adherence, treatment satisfaction, and therapeutic alliance.
This randomized controlled trial will allow us to determine the efficacy of behavioral activation treatment for depression in a fast-growing, yet highly underserved population in US mental health services. The study is also among the first to examine the effect of the proposed mechanisms of change of behavioral activation treatment for depression (that is, activity level and environmental reward) on depression over time. To our knowledge, this is the first randomized controlled trial to compare an empirical-supported treatment to a control supportive counseling condition in a sample of depressed, Spanish-speaking Latinos in the United States.
Clinical Trials Register: NCT01958840; registered 8 October 2013.
Trials 06/2014; 15(1):231. DOI:10.1186/1745-6215-15-231 · 1.73 Impact Factor
Available from: Daniela Golinelli
- "Despite substantial efforts by researchers, policy makers, and federal funding sources to improve access to mental health care for ethnic minority patients, disparities in access to, quality of, and outcomes of mental health interventions persist    . For example, Latinos suffer a disproportionate burden of disability from depression compared to Whites  because they are less likely to receive depression treatment and the treatment they do receive is often of poorer quality compared to treatment received by Whites   . "
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ABSTRACT: Concerns about the appropriate use of EBP with ethnic minority clients and the ability of community agencies to implement and sustain EBP persist and emphasize the need for community-academic research partnerships that can be used to develop, adapt, and test culturally responsive EBP in community settings. In this paper, we describe the processes of developing a community-academic partnership that implemented and pilot tested an evidence-based telephone cognitive behavioral therapy program. Originally demonstrated to be effective for urban, middle-income, English-speaking primary care patients with major depression, the program was adapted and pilot tested for use with rural, uninsured, low-income, Latino (primarily Spanish-speaking) primary care patients with major depressive disorder in a primary care site in a community health center in rural Eastern Washington. The values of community-based participatory research and community-partnered participatory research informed each phase of this randomized clinical trial and the development of a community-academic partnership. Information regarding this partnership may guide future community practice, research, implementation, and workforce development efforts to address mental health disparities by implementing culturally tailored EBP in underserved communities.
Depression research and treatment 09/2012; 2012:257858. DOI:10.1155/2012/257858
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