Ethnicity and Mental Health Treatment Utilization by Patients With Personality Disorders

Institute for Mental Health Research, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 01/2008; 75(6):992-9. DOI: 10.1037/0022-006X.75.6.992
Source: PubMed


The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic but not White participants, underscoring the importance of special attention to the treatment relationship with minority patients. These treatment use differences raise complex questions about treatment assessment and delivery, cultural biases of the current diagnostic system, and possible variation in PD manifestation across racial/ethnic groups. Future studies need to assess specific barriers to adequate and appropriate treatments for minority individuals with PDs.

Download full-text


Available from: John C Markowitz
  • Source
    • "Vulnerable populations experience significant levels of unmet need for mental health treatment (Bender et al. 2007; Wang et al. 2005); studies among vulnerable populations have found that less than one-third of those who need mental health treatment received it in the past year (Small 2010). Competing priorities are likely to inhibit the health-seeking behavior of persons with social vulnerabilities (Gelberg et al. 2000). "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is significant unmet need for mental health treatment among homeless men, but little is known about the correlates of treatment utilization in this population. Within the framework of the Behavioral Model for Vulnerable Populations, this study examines predisposing, enabling and need factors that may be associated with mental health care utilization. Participants were a representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row region of LA. Logistic regression examined the association between predisposing, enabling and need factors and past 30 day mental health service utilization on Skid Row. Results indicated that while need, operationalized as positive screens for posttraumatic stress disorder or depression, was associated with recent mental health care utilization, predisposing and enabling factors were also related to utilization. African-American homeless men, and those men who also reported substance abuse treatment and drop-in center use, had increased odds of reporting mental health care utilization.
    Full-text · Article · Mar 2014 · Community Mental Health Journal
  • Source
    • "Three of the five high quality scored studies considered race/ethnicity with regards to the treatment of PD [15,18,19]. They determined that more white patients with PD received treatment than black patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD. A systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity. There were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small. There is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.
    Full-text · Article · May 2010 · BMC Psychiatry
  • Source
    • "Instead, they were recruited by viewing a flyer advertising the study, which was placed extensively in the community and the Alachua County Health Department, or through a personal referral from health department staff or members of the community . Both of these recruitment strategies are common practice in public health research (Bender et al., 2007; Stice, Marti, Spoor, Presnell, & Shaw, 2008; Woolsey et al., 1954). To prevent contamination and reduce self-selection, recruiters and flyers described the study as a " general health study " without any mention of study specifics, such as a focus on HIV prevention and condom use, the offer of materials, or the presence of the observer/ counselor. "
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV-prevention intervention effectiveness depends on understanding whether clients with highest need for HIV-prevention counseling accept it. With this objective, a field study with a high-risk community sample from the southeastern United States (N = 350) investigated whether initial knowledge about HIV, motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use correlate with subsequent acceptance of an HIV-prevention counseling session. Ironically, participants with high (vs. low) motivation to use condoms, high (vs. low) condom-use-relevant behavioral skills, and high (vs. low) prior condom use were more likely to accept the HIV-prevention counseling. Moreover, the influence of motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use on acceptance of the counseling was mediated by expectations that the counseling session would be useful. Methods to reduce barriers to recruitment of clients for counseling programs are discussed.
    Full-text · Article · Sep 2009 · Journal of Consulting and Clinical Psychology
Show more