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Gender and Racial/Ethnic Differences in Use of Outpatient Mental Health and Substance Use Services by Depressed Adults

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Abstract

This study examines depressed adults’ use of mental health services, focusing on Latinos and African Americans. Self-report data for adults meeting CIDI criteria for major depression or dysthymia from the 1997–98 HealthCare for Communities Survey were analyzed. Gender stratified logistic regression models examined the relationship between race/ethnicity and outpatient mental health service use, controlling for sociodemographic, health status, insurance, and geographic characteristics. Latinas and African American women and men exhibited low use of outpatient mental health services. Similar results were observed in an insured subsample. Service use by minorities was more affected by financial and social barriers (e.g., stigma). No gender differences were observed in self-reported barriers to care. Concerted and continued efforts to promote access to mental health services are critical for minority men and women affected by depression; adults may have unmet mental health needs. Other vulnerable populations include older adults especially, men, and men in poor health.

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References

  1. Kessler R, Berglund P, Demler O, et al.: The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289(23):3095–3105, 2003.

    Article  PubMed  Google Scholar 

  2. Kessler RC: Gender differences in the prevalence and correlates of mood disorders in the general population. in Mood disorders in women, Edited by Steiner M, Yonkers KA, Eriksson E. London, UK: Martin Dunitz Ltd., 2000.

    Google Scholar 

  3. Breslau J, Kendler KS, Su M, Gaxiola-Aguilar S, Kessler RC: Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine 34:1–11, 2004.

    Article  Google Scholar 

  4. Vega W, Kolody B, Aguilar-Gaxiola S, Alderete E, Catalano R, Caraveo-Anduaga J: Lifetime prevalence of DSM-IIIR psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry 55(9):771–778, 1998.

    Article  PubMed  CAS  Google Scholar 

  5. Grant BF, Stinson FS, Hasin DS, Dawson DA, Chou SP, Anderson K: Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the united states: Results from the national Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61:1226–1233, 2004.

    Article  PubMed  Google Scholar 

  6. McGuire TG, Wells KB, Bruce ML, et al.: Burden of illness. Mental Health Services Research 4(4):179–185, 2002.

    Article  PubMed  Google Scholar 

  7. Miranda J, Bernal G, Lau A, Kohn L, Hwang W-C, LaFromboise T: State of the science on psychosocial interventions for ethnic minorities. Annual Review of Psychology 1:113–142, 2005.

    Article  Google Scholar 

  8. Institute of Medicine, ed. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.

    Google Scholar 

  9. U.S. Department of Health and Human Services: Mental health: A report of the surgeon general. Rockville, MD., U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Mental Health, 1999.

  10. U.S. Department of Health and Human Services: Mental health: Culture, race, and ethnicity– a supplement to mental health: A report of the surgeon general. Rockville, MD, U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

  11. Cleary P, Mechanic D, Greenley J: Sex differences in medical care utilization: An empirical approach. Journal of Health and Social Behavior 23(June):106–119, 1982.

    Article  PubMed  CAS  Google Scholar 

  12. Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA: National trends in the outpatient treatment of depression. Journal of the American Medical Association 287(2):203–209, 2002.

    Article  PubMed  Google Scholar 

  13. Vega WA, Kolody B, Aguilar-Gaxiola S, Catalano R: Gaps in service utilization by Mexican-Americans with mental health problems. American Journal of Psychiatry 156:928–934, 1999.

    PubMed  CAS  Google Scholar 

  14. Narrow WE, Regier DA, Norquist G, Rae DS, Kennedy C, Arons B: Mental health service use by Americans with severe mental illness. Social Psychiatry and Psychiatric Epidemiology 35:147–155, 2000.

    Article  PubMed  CAS  Google Scholar 

  15. Vega WA, Kolody B, Aguilar-Gaxiola S: Help-seeking for mental health problems among Mexican Americans. Journal of Immigrant Health 3(3):133–140, 2001.

    Article  PubMed  CAS  Google Scholar 

  16. Peifer KL, Hu T-w, Vega WA: Help seeking by persons of Mexican origin with functional impairments. Psychiatric Services 51(10):1293–1298, 2000.

    Article  PubMed  CAS  Google Scholar 

  17. Mojtabai R, Olfson M, Mechanic D: Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry 59:77–84, 2002.

    Article  PubMed  Google Scholar 

  18. Swartz MS, Wagner HR, Swanson JW, Burns LK, George LK, Padgett DK: Comparing use of public and private mental health services: The enduring barriers of race and age. Community Mental Health Journal 34(2):133–144, 1998.

    Article  PubMed  CAS  Google Scholar 

  19. Gallo JJ, Marino S, Ford D, Anthony JC: Filters on the pathway to mental health care, ii. Sociodemographic factors. Psychological Medicine 25(6):1149–1160, 1995.

    Article  PubMed  CAS  Google Scholar 

  20. Miranda J, Cooper LA: Disparities in care for depression among primary care patients. Journal of General Internal Medicine 19:120–126, 2004.

    Article  PubMed  Google Scholar 

  21. Alegria M, Canino G, Rios R, et al.: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-latino whites. Psychiatric Services 53(12):1547–1555, 2002.

    Article  PubMed  Google Scholar 

  22. Wells KB, Klap R, Koike A, Sherbourne CD: Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry 158(12):2027–2032, 2001.

    Article  PubMed  CAS  Google Scholar 

  23. Young AS, Klap R, Sherbourne CD, Wells KB: The quality of care for depressive and anxiety disorders in the United States. Archives of General Psychiatry 58(1):55–61, 2001.

    Article  PubMed  CAS  Google Scholar 

  24. Snowden L, Thomas K: Medicaid and African American outpatient mental health treatment. Mental Health Services Research 2(2):115–120, 2000.

    Article  PubMed  CAS  Google Scholar 

  25. Husaini BA, Sherkat DE, Levine R, et al.: Race, gender, and health care service utilization and costs among Medicare elderly with psychiatric diagnoses. Journal of Aging and Health 14(1):79–95, 2002.

    Article  PubMed  Google Scholar 

  26. Sturm R, Gresenz C, Sherbourne CD, et al.: The design of healthcare for communities: A study of health care delivery for alcohol, drug abuse, and mental health conditions. Inquiry 36(Summer):221–233, 1999.

    PubMed  CAS  Google Scholar 

  27. Wells KB, Sherbourne CD, Sturm R, Young AS, Burnam A: Alcohol, drug abuse, and mental health care for uninsured and insured adults. Health Services Research 37(4):1055–1066, 2002.

    Article  PubMed  Google Scholar 

  28. Gresenz C, Stockdale SE, Wells KB: Community effects on access to behavioral health care. Health Services Research 35(1):293–306, 2000.

    PubMed  CAS  Google Scholar 

  29. McGuire TG, Alegria M, Cook BL, Wells KB, Zaslavsky A: Implementing the IOM definition of disparities: An application to mental health care. Unpublished, 2005.

  30. United States Department of Health and Human Services. HHS regional offices. Available at: http://www.hhs.gov/about/regions/. Accessed July, 2004.

  31. Albizu-Garcia CE, Alegria M, Freeman D, Vera M: Gender and health services use for a mental health problem. Social Science and Medicine 53:865–878, 2001.

    Article  PubMed  CAS  Google Scholar 

  32. U.S. Census Bureau Population Division. Projections of the resident population by race, Hispanic origin, and nativity: Middle series, 2025–2045. January 13, 2000.

  33. Wells KB, Sherbourne CD, Schoenbaum M, et al.: Five-year impact of quality improvement for depression. Archives of General Psychiatry 61:378–386, 2004.

    Article  PubMed  Google Scholar 

  34. Lebowitz BD, Pearson JL, Schneider LS, et al.: Diagnosis and treatment of depression in late life: Consensus statement update. Journal of the American Medical Association 278(14):1186–1190, 1997.

    Article  PubMed  CAS  Google Scholar 

  35. Crystal S, Sambamoorthi U, Walkup J, Akincigil A: Diagnosis and treatment of depression in the elderly Medicare population: Predictors, disparities, and trends. Journal of the American Geriatrics Society 51:1718–1728, 2003.

    Article  PubMed  Google Scholar 

  36. Gottfries C-G: Depression in the elderly. in Mood disorders in women, Edited by Steiner M, Yonkers KA, Eriksson E. London, England: Martin Dunitz, 2000.

    Google Scholar 

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Acknowledgments

The authors are grateful to Margarita Alegría, Ph.D., Glorisa Canino, Ph.D., Peter Guarnaccia, Ph.D., and Rafael Ramirez, Ph.D., for their comments on earlier drafts of this manuscript, and to Benjamin Cook, MPH and Robert Wolf, MS, for statistical guidance. The work was funded through the National Institute of Mental Health National Research Service Fellowship Post-Doctoral Traineeship provided to Victoria Ojeda under the directorship of Dr. Richard Frank, grant #T32-MH 019733-10, and the NIH funded Project: EXPORT Grant # P20 MD000537.

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  1. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, USA

    Victoria D. Ojeda Ph.D., M.P.H. & Thomas G. McGuire Ph.D.

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  1. Victoria D. Ojeda Ph.D., M.P.H.
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  2. Thomas G. McGuire Ph.D.
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Correspondence to Victoria D. Ojeda Ph.D., M.P.H..

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Ojeda, V.D., McGuire, T.G. Gender and Racial/Ethnic Differences in Use of Outpatient Mental Health and Substance Use Services by Depressed Adults. Psychiatr Q 77, 211–222 (2006). https://doi.org/10.1007/s11126-006-9008-9

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  • DOI: https://doi.org/10.1007/s11126-006-9008-9

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