Mental Health Service Utilization by African Americans and Whites
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Medical Care
(Impact Factor: 3.23).
11/1999; 37(10):1034-45. DOI: 10.1097/00005650-199910000-00007
To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s.
Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996.
The Baltimore Epidemiologic Catchment Area (ECA) Follow-Up.
Subjects included 1,662 adults (590 African Americans and 1,072 whites).
Use of mental health services, defined as talking to any health professional about emotional or nervous problems or alcohol or drug-related problems within the 6 months preceding each interview.
In 1981, crude rates of mental health service use in general medical (GM) settings and specialty mental health settings were similar for African Americans and whites (11.7%). However, after adjustment for predisposing, need, and enabling factors, individuals receiving mental health services were less likely to be African American. Mental health service use increased by 6.5% over follow-up, and African Americans were no longer less likely to report receiving any mental health services in the 1990s. African Americans were more likely than whites to report discussing mental health problems in GM settings without having seen a mental health specialist. They were less likely than whites to report use of specialty mental health services, but this finding was not statistically significant, possibly because of low rates of specialty mental health use by both race groups. Psychiatric distress was the strongest predictor of mental health service use. Attitudes positively associated with use of mental health services were more prevalent among African Americans than whites.
Mental health service use increased in the past decade, with the greatest increase among African Americans in GM settings. Although it is possible that the racial disparity in use of specialty mental health services remains, the GM setting may offer a safety net for some mental health concerns of African Americans.
Available from: Lara Stepleman
- "In primary care settings, symptom minimization or misattribution of depression symptoms to other causes by providers (Sleath, Svarstad, & Roter, 1998) and patient presentation with somatic rather than mood symptoms (Brown, Schulberg, & Madonia, 1996) have been found to contribute to compromised depression detection for Blacks. Blacks have been found to be as likely as Whites to discuss mental health problems in a medical setting (Ford, Kamerow, & Thompson, 1988) but less likely to seek or receive specialty mental health care (Bottonari & Stepleman, 2010; Cooper-Patrick et al., 1999). If Blacks, having a more disabling MS course, also go undetected for clinically significant depression, it could further negatively influence MS medical outcomes and quality of life. "
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ABSTRACT: Depression is prevalent in Multiple Sclerosis (MS) and impacts treatment adherence. Depression screening may be a useful mechanism to identify Blacks at risk for depression in an MS setting, as they frequently experience more disabling MS disease and also may be less likely than Whites to be accurately diagnosed with depression, which can further impact MS disease and diminish quality of life. The purpose of this study was to compare the clinical presentation (e.g. psychiatric histories, current symptoms, and provider treatment recommendations) of Black and White MS patients identified as at risk for depression using a validated depression screening instrument. Secondary analysis of an archival chart data-set of 279 MS patients (90 Blacks) indicated that Black patients were less likely than Whites to have a past mental health diagnosis (X (2) = 12.794, p < .001), prior experience with psychotropics (X (2) = 11.394, p < .001), or be prescribed psychotropics at the time of screening (X (2) = 10.225, p < .001). No differences in depression scores were observed between Black and White patients. Approximately 44% of patients received provider treatment recommendations following a positive screening with no between group differences in the likelihood of receiving at least one recommendation. Consistent with the literature, our Black patient sample was less likely than Whites to have a history of mental health diagnosis or to have been treated with psychotropics. Although more research is needed, screening programs for depression in MS may facilitate access to services for all MS patients while reducing health disparities in Black American patients and removing barriers to early intervention and ongoing care.
Available from: Laura N Gitlin
- "Moreover, studies consistently show that African Americans continue to obtain poorer quality of depression care than White patients [9,10,18,19]. Barriers to depression care persist at the patient level and include stigma and lack of depression knowledge [11,20]; provider level due to lack of knowledge and training in assessment and treatments , and systems level due to lack of care coordination and sustainable infrastructures . Persistence of mental health disparities for older African Americans in the USA, higher depression rates than previously found, coupled with continued unequal access to culturally relevant mental health treatments, point to the need to advance more powerful care models and interventions for this group. "
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ABSTRACT: Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness.
Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated.
BTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month.
Available from: Clifford L Broman
- "(Narrow, Rae, Robins, & Regier, 2000; Padgett, Patrick, Burns, & Schlesinger, 1994; Shi, 2000; Snowden & Yamada, 2005). Studies show that although there are many U.S. citizens with mental disorders who do not use mental health services, the level of unmet need for mental health care is substantially higher for Blacks and Latinos than it is for White Americans, even though overall rates of disorder are roughly equivalent by race-ethnicity (Cooper-Patrick et al., 1999; Wang et al., 2005). Adult Latinos and Blacks receive about half as much outpatient mental health care as Whites. "
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ABSTRACT: This study investigates race and ethnic differences in the receipt of mental health services among young adults. Research has indicated that racial minorities receive treatment at a much lower rate than those with middle and upper incomes and whites. We use data from the National Longitudinal Study of Adolescent Health, a nationally representative study of young adults, first interviewed when in Grades 7 through 12. We find significant differences across race-ethnicity. Consistent with prior research, blacks are less likely to have received mental health services. Findings for gender and education differed from previous studies. The relationship of gender on services receipt is mediated by depression. The relationship of race-ethnicity on services receipt is moderated by levels of education and prior services use. Education is associated with greater services use for Whites, but less services use for blacks. Also, blacks who used services in the past are significantly less likely to be current users. The implications of these results are discussed.
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