Racial/Ethnic Differences in Parental Endorsement of Barriers to Mental Health Services for Youth

The present study investigated parental endorsement of barriers to care in a racially/ethnically diverse, at-risk sample of youth with mental health needs by testing the following hypotheses: (1) African American, Asian/Pacific Islander American, and Latino youth would have higher levels of unmet need compared to Non-Hispanic Whites (NHWs); (2) Parents of ethnic minority youth would report a greater number of barriers to mental health services for their children than would parents of NHWs; (3) The pattern of greater barrier endorsement by parents of ethnic minorities compared to parents of NHWs would persist across different barrier types; (4) Barrier endorsement would be related to unmet need for mental health services. As hypothesized, ethnic minority youth had higher levels of unmet need as compared to NHWs. However, despite this finding, parents of ethnic minority youth reported fewer barriers than did parents of NHWs, and this pattern generally persisted across barrier types. Furthermore, barrier endorsement was unrelated to unmet need. Post hoc analyses suggest the influence of cultural factors upon barrier endorsement, indicating the importance of taking such influences into account in future research on barriers to care.     

Racial/Ethnic Disparities in Parent Perception of Child Need for Mental Health Care Following School Disciplinary Events

Disciplinary problems at school potentially affect parent perception of child need for mental health care. This article explores effects of a child's first school suspension or expulsion on parent perception of child need for services in three racial-ethnic subgroups. Subjects were mothers participating in a national longitudinal study and their children. First-time school suspension or expulsion positively affected service use and parent-reported service need among white non-Hispanic children, but had little or no effect for African American and Hispanic children. These results suggest that information on child behavior provided to parents by teachers and school administrators can influence parent perception of child service need, but that racial-ethnic differences may exist in parent interpretation of and response to this information. Culturally appropriate approaches to relaying information to parents about child service need may help reduce these differences.     

Racial/Ethnic Differences in the Association Between Symptoms of Depression and Self-rated Mental Health Among Older Adults

The study examined racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults. Data came from the first wave of the National Social Life, Health, and Aging Project, a population-based study of non-institutionalized older adults aged 57 to 85. The sample consisted of non-Hispanic Whites (n = 2,110), Blacks (n = 509), and Hispanics (n = 304). The association between symptoms of depression and self-rated mental health was weaker among minority groups than that among non-Hispanic Whites. Tests of interaction effects showed that the predictability of depressive symptoms to self-rated mental health was substantially weakened among Blacks of advanced ages and Hispanics with multiple chronic conditions. The study explored potential sources of racial/ethnic differences in subjective reports of mental health and called attention to older minorities with advanced ages and cormorbid conditions in mental health services and interventions.     

Distance Matters in Choice of Mental Health Program: Policy Implications for Reducing Racial Disparities in Public Mental Health Care

The purpose of this study is to examine the influence of race, geographic distance and quality on the choice of community mental health programs. The study population was comprised of adult Medicaid recipients who received outpatient treatment for serious mental illness in FY 2001. A discrete choice model was employed to examine the likelihood of choosing one program over another. Quality was measured based on follow-up after hospital discharge and continuity of care in outpatient services. Maps showing the relationship between race and the quality of care were prepared to visually confirm the results of the statistical analysis. African American and Hispanic clients were less likely to travel further for treatment, while no significant difference was found between the Caucasian and other race groups. Caucasian subjects were more likely to choose programs with a higher quality of care compared to Hispanic or African American clients. Higher income clients were, on average, traveling longer and receiving better quality of care after controlling for race. The results suggested that clients living in higher income White neighborhoods are more likely to travel longer distances for mental health treatment. Special attention must be paid to improve the quality of care in lower income minority neighborhoods to insure equity of treatment in publicly funded programs.     

Capitation and Racial and Ethnic Differences in Use and Cost of Public Mental Health Services

This study investigated racial and ethnic differences in the probability of mental health service use and costs of treatment before and after the implementation of capitated financing. Models were created to test effects on utilization and costs of African American, Latinos, and white mental health consumers. As service use and costs declined under capitation, Latino, and white levels of use and cost tended to converge. African American utilization patterns in the capitated areas tended to parallel their white counterparts. Differential rejection by, or exclusion of, African American and Latino consumers did not appear to occur in response to capitation. This project is supported by the National Institute of Mental Health, Grant R01 MH 54136. Preliminary analyses were presented at the Association for Health Services Research Annual Meeting, Los Angeles, 2000.     

Exploring the Relationship Between Race/Ethnicity,Age of First School-Based Services Utilization,and Age of First Specialty Mental Health Care for At-Risk Youth

This study investigated race/ethnic variations in age of entry into school-based services and specialty mental health outpatient services among 1552 high-risk youths served in a publicly funded system of care. Non-Hispanic White youths were more likely to receive school-based services as compared to ethnic minority groups, and to begin use at an earlier age. In addition, the earlier a child was identified for school-based services, the earlier the child first utilized specialty outpatient mental health services. Multiple regression models showed that inclusion of race/ethnicity as a predictor significantly increased the overall variance explained in the model predicting age of first school-based services, and both race/ethnicity and first use of school-based services increased the overall variance explained in the model predicting age of first specialty mental health outpatient service use. The results suggest that involvement in school-based services may play an important role in facilitating specialty outpatient mental health service use for youths.     

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

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.     

Racial/Ethnic Differences in Correspondence Between Subjective Cognitive Ratings and Cognitive Impairment

ObjectivesResponding to racial/ethnic disparities in dementia diagnosis and care, we examined the role of race/ethnicity in the correspondence between subjective and objective ratings of cognitive impairment. Our examination focused on the two types of discordance: (1) positive ratings in the presence of cognitive impairment and (2) negative ratings in the absence of cognitive impairment.Design and ParticipantsA cross-sectional assessment was conducted using the data from the Harmonized Cognitive Assessment Protocol project, a sub-study of the Health and Retirement Study. Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics.MeasurementsDiscordant groups were identified based on self-ratings of cognition (positive versus negative) and the Langa–Weir classification of cognitive impairment (normal versus impaired).ResultsBlacks and Hispanics were more prone to falsely positive perceptions of their cognitive function in the presence of cognitive impairment than non-Hispanic Whites. On the other hand, non-Hispanic Whites were more likely to manifest negative ratings even in the absence of cognitive impairment.ConclusionOur findings demonstrate the critical role of race/ethnicity in determining discordance between subjective and objective measures of cognition and highlight the importance of a tailored effort to promote dementia diagnosis and care.     

Racial/Ethnic Disparities in Depression and Its Theoretical Perspectives

The purpose of this review is to look at racial/ethnic disparities in the diagnosis of depression and its treatment and to explain the dynamics and causes of these racial/ethnic disparities in depression by looking at several theories, such as perceived racism, cultural competency, and other theories. Perceived racism is that the perceptions of an environmental stimulus as being racist affects the coping responses of ethnic/racial minorities, which alters psychological and physiological stress responses, and finally affects health outcomes negatively. A lower level of cultural competence can lead to health disparities. In addition, lower socioeconomic status and health care providers’ beliefs and behaviors about patients’ race/ethnicity and class can affect depressive symptoms as well as diagnosis and treatment. In order to reduce these racial/ethnic disparities in depression, diverse interventions should be developed to improve depression outcomes for ethnic minority populations based on these theoretical perspectives.     

Mental Health and Substance Abuse Services to Parents of Children Involved with Child Welfare: A Study of Racial and Ethnic Differences for American Indian Parents

American Indian (AI) parents of children involved with child welfare were compared to White, Black and Hispanic parents on mental health and substance abuse problems and access to treatment. Data came from the National Study of Child and Adolescent Well-Being, a longitudinal study of a nationally representative sample of children aged 0–14 years involved with child welfare. Weighted statistics provided population estimates, and multivariate logistic regression was used to predict the likelihood of caregivers receiving mental health or substance abuse services. There were significant disparities in the likelihood of receiving mental health, but not substance abuse, services. Unmet need for mental health and substance abuse treatment characterized all parents in this study. AI parents fared the worst in obtaining mental health treatment. Parents of children at home and of older children were less likely to access mental health or substance abuse treatment.     

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009–2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.     

Racial/Ethnic Disparities in Admissions to Public and Private Psychiatric Inpatient Settings: The Effect of Managed Care

This study investigates the effect of managed care on access patterns among people of color who are severely and persistently mentally ill. The distribution of admissions to public and private psychiatric hospitals was compared for African-American, Asian, Latino, and white case managed clients of the Massachusetts Department of Mental Health before and after implementation of Medicaid managed mental health care in October 1997. Managed care appears to have increased access to private services across all racial and ethnic groups, although admissions of non-white patients were still more likely to take place in publicly operated settings. These data suggest that equalizing access to putatively better inpatient treatment settings may be an externality of managed care.