National trends in ethnic disparities in mental health care.
ABSTRACT 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.
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ABSTRACT: Latinos in the United States (U.S.) experience disparities in the detection and treatment of mental disorders. Although previous research has found that Latinos prefer individual psychotherapy and treatment in a primary care setting for common trauma-related mental disorders (e.g., depression, posttraumatic stress disorder), reasons for these treatment preferences are not fully understood and preferences regarding other mental health treatment characteristics are not known. Using a mixed-methods approach, the current study sought to identify preferences for treatment modality, type of psychotherapy, type of provider, and setting, as well as the influences of logistical factors and potential barriers on the help-seeking behaviors of trauma-exposed Latina immigrants who met screening criteria for PTSD and/or depression and were receiving health care in a primary care clinic. Consistent with previous research, participants expressed a preference for individual therapy, particularly supportive psychotherapy and cognitive–behavioral therapy. Participants preferred receiving mental health care in a primary care clinic by a mental health specialist. Cost emerged as the most important logistical consideration when determining whether to seek services. Unfamiliarity with mental health services and confidentiality concerns, particularly regarding immigration status, were identified as additional barriers that may decrease the likelihood of seeking treatment for depression or PTSD. Providers will need to be creative in incorporating the treatment preferences of Latinos in cost-efficient interventions. Efforts to decrease the mental health disparities faced by the growing Latino population may include psychoeducation, hybrid treatments, and systems-level interventions to integrate mental health treatment into primary care settings. (PsycINFO Database Record (c) 2014 APA, all rights reserved)Psychological Trauma Theory Research Practice and Policy 01/2014; 6(1):83. · 0.89 Impact Factor
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ABSTRACT: Latinos with limited English proficiency (LEP) experience multiple barriers to accessing efficacious mental health treatments. Using a stage model of behavior therapy research, this Stage I investigation evaluated the Brief Behavioral Activation Treatment for Depression (BATD), an intervention that may be well equipped to address existing treatment barriers. A sample of 10 Latinos with LEP and depressive symptomatology participated in a 10-session, direct (i.e., literal) Spanish-language translation of BATD, with no other cultural modifications. Participants were assessed at each session for depressive symptomatology and for the proposed BATD mechanisms: activity engagement and environmental reward. One month after treatment, participants were reassessed and interviewed to elicit feedback about BATD. Hierarchical linear model analyses were used to measure BATD outcomes. Results showed depressive symptomatology decreased (p<.001), while both activation (p=.04) and environmental reward (p=.02) increased over the course of BATD. Increases in activation corresponded concurrently with decreases in depression (p=.01), while environmental reward preceded decreases in depressive symptomatology (all p's≤.04). Follow-up analyses revealed sustained clinical gains in depression and activation, and an increase in environmental reward at follow-up. Participant interviews conducted 1month after treatment conclusion indicated that BATD is an acceptable treatment for our sample of interest. Despite the limitations inherent in a study restricted to a sample of 10, preliminary outcomes of this Stage I research suggest that members of this otherwise underserved group showed improvements in depressive symptomatology and are willing to participate in and adhere to BATD. The study's positive outcomes suggest that a Stage II randomized clinical trial is a logical next step.Behavior therapy 01/2014; 45(1):102-15. · 2.85 Impact Factor
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ABSTRACT: A growing body of literature indicates that ethnic differences exist in the rates of retention and engagement in mental health services, and that these disparities stem partly from the inability of services to fulfill the needs and expectations of ethnic minority populations, including Latinos. Increasing the involvement of Latinos in their own mental health treatment may be an important component for improving their care and increasing their participation in treatment. The Right Question Project (RQP) is an educational strategy that encourages active participation in decisions that are important to the individual by facilitating a person's ability to formulate effective questions and to engage others in an instructive dialogue and shared decision making. The purpose of this article is to describe how this strategy, developed by a community group, was adapted and tailored for use in a mental health setting, with the intention of shifting the level of the client's active involvement with their providers in order to improve attendance at scheduled appointments and retention in mental health care. The article highlights the advantages of using practical interventions that originate from the community to improve the quality of services available to Latinos. At the same time, it reveals challenges and limitations that shaped implementation decisions, especially in terms of cultural, socioeconomic, and systemic factors affecting Latino participants. Implications for mental health providers, trainees, and supervisors are discussed.Professional Psychology Research and Practice 01/2012; 43(3):208-216. · 1.34 Impact Factor