Help seeking for mental health problems among Mexican Americans

This study uses data from a household survey (Mexican American Prevalence and Services Study; MAPSS) of 3,000 respondents in Fresno County, California, to 1) contrast use across multiple sectors of care among immigrant and U.S. born Mexican Americans with recent psychiatric disorders, 2) contrast multiple provider utilization patterns, and 3) identify specific factors associated with the use of mental health specialty and general medical sectors. Immigrants and U.S. born disproportionately used the general medical sector for treating mental health problems. The U.S. born were more likely to use family physicians and counselors than were immigrants, and neither relied heavily upon informal network providers to treat psychiatric disorders. A comparison of patterns showed that most people with a recent disorder used a combination of providers. The logistic regression analyses showed that knowing where to find a provider increased the likelihood of specialty mental health use by an odds ratio (O.R.) of 4.68. Private insurance increased use of mental health providers, O.R. = 3.76. Public insurance availability did not increase mental health provider use, suggesting that other factors were linked to use of mental health specialty care. Public insurance did increase medical sector care for psychiatric problems, O.R. = 2.57. Poor self-rated mental health status was primarily associated with use of physicians by U.S. born (O.R. = 5.39). Severe mental health impairment increased use of both general medical (O.R. = 5.54) and specialty mental health (O.R. = 5.1) providers. These results point out that eligibility for public insurance is a necessary but not sufficient status to increase mental health sector care among immigrants, and education and more effective referral from other sectors are needed to encourage use of these services.     

Treatment of Depression in Rural Arkansas: Policy Implications for Improving Care

Policy-makers have long suspected that greater barriers to care result in depressed rural residents being less likely to receive high-quality treatment. This study recruited 470 depressed community residents in a 1992 telephone survey, followed 95 percent of them through one year, and abstracted additional data on their health care utilization from insurance claims, medical and pharmacy records. Bivariate and multivariate models demonstrated that during the year following the baseline, there were no significant rural-urban differences in the rate (probability of any outpatient depression treatment), type (probability of receiving general medical depression care only), or quality (completion of guideline-concordant acute-stage care) of outpatient depression treatment. Annual expenditures for outpatient depression treatment were lower for rural subjects compared with their urban counterparts. Rural subjects had 3.05 times the odds of being admitted to a hospital for physical problems and 3.06 times the odds of being admitted to a hospital for mental health problems during the year following baseline compared with urban subjects. Cost-offset analyses demonstrate that every dollar invested in depression treatment was associated with a $2.61 decrease in the cost of treating physical problems in depressed rural residents. Limited insurance coverage and limited availability of services were the most significant barriers to specialty and general medical outpatient treatment for depression in both rural and urban residents. More than 80 percent of depressed residents in both rural and urban areas visited a primary care provider during the year following baseline. The potential cost offset of depression treatment in rural populations plus the improvement in productivity observed in both rural and urban populations indicate that it may be economically possible to improve quality of care for depression without bankrupting an already strained health care budget.     

Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.

The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.     

Ethnic populations in public mental health: services choice and level of use.

BACKGROUND. Barriers to access and use of mental health care by Asians, Blacks, and Hispanic Americans have been a source of concern for many years. Limitations in our knowledge base persist regarding patterns of use in public sector programs of certain services. Using a sample of almost 27,000 persons, this study examined access and level of use by ethnic minority groups of emergency services, inpatient care, individual outpatient visit, and case management. METHODS. Data from the management information systems of San Francisco and Santa Clara counties were analyzed for fiscal year 1987/1988. Multivariate models were evaluated at two stages, reflecting whether or not a service had been used, and if used, the level of use. RESULTS. Asians and Hispanics used less emergency and inpatient but more outpatient care than did Whites; Blacks used more emergency and less outpatient care. CONCLUSIONS. Ethnicity continues to play a role in understanding the utilization of mental health services. Regarding emergency and inpatient care, Asian and Hispanic patterns of use appear relatively favorable, whereas the patterns of Blacks continue to be problematic.     

Neighborhood residential segregation and mental health: A multilevel analysis on Hispanic Americans in Chicago

Compared with the relationship between neighborhood-level residential segregation and physical health of Hispanic Americans, less is known about how neighborhood residential segregation affects mental health. This study examines if, and how, neighborhood residential segregation is associated with the mental health of Puerto Rican and Mexican Americans in Chicago. Multilevel analyses reveal that neighborhood residential segregation is positively associated with depressive symptoms and anxiety in both groups. Neighborhood segregation, however, has more salient effects on the mental health of Mexican Americans. For Puerto Rican Americans, the effects of neighborhood segregation on mental health become nonsignificant after controlling for neighborhood-level income and individual-level covariates, whereas neighborhood segregation is strongly associated with the mental health of Mexican Americans even after controlling for other covariates. These findings show that living in a Mexican American-dominated community is not beneficial to mental health, in contrast to findings for physical health shown in previous studies.     

Racial and Ethnic Disparities in the Use of Mental Health Services

The authors used data from the 1998-1999 Community Tracking Study (CTS) household survey to examine variations in predictors of use of mental health services among different racial and ethnic groups (white, African American, Hispanic, and other). African Americans and Hispanics were less likely to have visited a mental health professional (MHP) in the prior year than were whites. Independent of health insurance and health status, low- to middle-income African Americans may be at particular risk for inadequate use of an MHP compared to higher-income African Americans. Similarly, upper-income Hispanics were more likely to have visited an MHP than Hispanics in the lowest income range. Adults aged 50 and older were less likely to visit an MHP than individuals aged 18-49. Depressed men were more likely to visit an MHP than depressed women. Efforts to reduce disparities should focus on lower-income racial and ethnic minorities.     

Adverse effects of acculturation: psychological distress among Mexican American young adults

We examined the relationship between acculturation and psychological distress in young (20-30), middle aged (31-50), and older adult (51-74) Mexican Americans (n = 3084). The data were from the Hispanic Health and Nutrition Examination Survey (HHANES). Acculturation was measured with items on spoken and written language and ethnic identification. Psychological distress was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). We found that as acculturation increased, distress significantly increased in young adults but tended to decrease in older adults. This general pattern held for males and females and was consistent for the CES-D total score and caseness rates. The effects of acculturation were independent of the effects of income and education. We discuss that alienation and discrimination may be two intervening events producing the psychological distress of the highly acculturated young adults. Further, our findings tentatively suggest a longitudinal process whereby acculturated younger Mexican Americans attempting to advance themselves economically and socially in the dominant society strip themselves of traditional resources and ethnically-based social support. Through the years, however, they may re-establish ties to their native culture which contributes to relatively positive mental health.     

Perceived discrimination and health among Puerto Rican and Mexican Americans: Buffering effect of the Lazo matrimonial?

An emerging body of research shows that perceived discrimination adversely influences the mental health of minority populations, but is it also deleterious to physical health? If yes, can marriage buffer the effect of perceived discrimination on physical health? We address these questions with data from Puerto Rican and Mexican American residents of Chicago. Multivariate regression analyses reveal that perceived discrimination is associated with more physical health problems for both Puerto Rican and Mexican Americans. In addition, an interaction effect between marital status and perceived discrimination was observed: married Mexican Americans with higher perceived discrimination had fewer physical health problems than their unmarried counterparts even after adjusting for differential effects of marriage by nativity. The findings reveal that perceived discrimination is detrimental to the physical health of both Puerto Rican and Mexican Americans, but that the stress-buffering effect of marriage on physical health exists for Mexican Americans only.     

Depression and Antidepressant Use Among Asian and Hispanic Adults: Association with Immigrant Generation and Language Use

This research investigates the psychological well-being and usage of medical treatments by Asian and Hispanic immigrant descendants. Using data from all four waves of Add Health study, this paper focuses on two outcomes: (1) depression and (2) levels of antidepressant use by race/ethnicity, immigrant generation, and linguistic acculturation levels during adulthood. Findings reveal that depression is prevalent among Mexican Americans, other Hispanics, and Asian Americans. Furthermore, Mexican Americans and Asian Americans have reported a lower level of antidepressant use than whites, with Asian Americans attaining the lowest level when immigrant generation, language acculturation levels, and other socioeconomic factors are held constant. We also find that those who are linguistically less acculturated have much lower levels of antidepressant use than their monolingual English-speaking counterparts.     

Stability and change in health insurance among older Mexican Americans: longitudinal evidence from the Hispanic established populations for epidemiologic study of the elderly

OBJECTIVES: This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals. METHODS: We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE). RESULTS: The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage. CONCLUSIONS: The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage.     

A Cross-National Study on Prevalence of Mental Disorders,Service Use,and Adequacy of Treatment Among Mexican and Mexican American Populations

Objectives. We examined differences in the use of mental health services, conditional on the presence of psychiatric disorders, across groups of Mexico’s population with different US migration exposure and in successive generations of Mexican Americans in the United States.Methods. We merged surveys conducted in Mexico (Mexican National Comorbidity Survey, 2001–2002) and the United States (Collaborative Psychiatric Epidemiology Surveys, 2001–2003). We compared psychiatric disorders and mental health service use, assessed in both countries with the Composite International Diagnostic Interview, across migration groups.Results. The 12-month prevalence of any disorder was more than twice as high among third- and higher generation Mexican Americans (21%) than among Mexicans with no migrant in their family (8%). Among people with a disorder, the odds of receiving any mental health service were higher in the latter group relative to the former (odds ratio = 3.35; 95% confidence interval = 1.82, 6.17) but the age- and gender-adjusted prevalence of untreated disorder was also higher.Conclusions. Advancing understanding of the specific enabling and dispositional factors that result in increases in mental health care may contribute to reducing service use disparities across ethnic groups in the United States.Epidemiological studies have found that migration from Mexico to the United States is associated with a dramatic increase in psychiatric morbidity. Risk for a broad range of psychiatric disorders, which is relatively low in the Mexican general population, is higher among Mexican-born immigrants in the United States and higher still among US-born Mexican Americans.1–5 Risk among US-born Mexican Americans is similar to that of the non-Hispanic White population.6 Recent research suggests that the association between migration and mental health extends into Mexico, where return migrants and family members of migrants are at higher risk for substance use disorders than those with no migrant in their family.3,7Little is known about the influence of cultural and social changes associated with migration on the use of mental health services. As the mental health system is much more extensive8 and use of mental health service is much more common9 in the United States than in Mexico, we expect that Mexican Americans would use mental health services more frequently than their counterparts in Mexico. However, it is not known whether the increase in service use keeps pace with the increase in prevalence of psychiatric disorders. Moreover, in the United States, Hispanics in general and Mexican Americans in particular are less likely to receive mental health services than are non-Hispanic Whites,10–12 and immigrants are less likely to use mental health services than the US born, particularly if they are undocumented.13We made use of a unique data set formed by merging surveys conducted in Mexico and the United States that used the same survey instrument. We used these data to examine differences in past-year mental health service use, conditional on the past-year prevalence of psychiatric disorder, associated with migration on both sides of the Mexico–US border.     

Cost-sharing and the use of general medical physicians for outpatient mental health care.

Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.     

The mental health needs of Mexican-American agricultural workers

We used three measurement procedures to produce a comprehensive profile of the mental health needs of Mexican-American farmworkers and to determine what kinds of mental health services were required to meet those needs. These measurement procedures were a field survey, a key informant survey, and a nominal group process. The results of the field survey indicated that rural Mexican Americans are not being served by mental health providers, despite their having higher symptom levels than would be expected in the general population and their substantial use of rural primary health clinics and private physicians. The key informant survey included mental health providers, health providers, and community agency personnel. According to these informants, the mental health sector is unable to provide services for the farmworkers; and the ability of other providers to reach them depends on a number of factors, including the nature of the services offered and the socioeconomic characteristics of the farmworkers themselves. Key informants identified the environmental conditions implicated in the farmworkers' psychosocial problems and recommended types of services, sites, and key personnel. Key informants concurred that general health settings and multiservice agencies were the most appropriate for reaching Mexican Americans, and that mental health services must include bilingual and bicultural staff members. Key informants disagreed, however, about the relative value of certain kinds of mental health services. The nominal group process identified 32 design criteria that could be used to improve mental health services for farmworkers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border

Understanding influences on health-related quality of life (HRQL) is critical in order to track and improve the health of poor, vulnerable populations and reduce health disparities. However, studies assessing HRQL of minorities are relatively scarce. The purpose of this study was to document personal and socioenvironmental correlates to HRQL. The study population is Mexican Americans in the Texas-Mexico border region living in colonias - unincorporated, impoverished settlements with substandard living conditions along the U.S.-Mexico border. Mexican Americans living in colonias are one of the most disadvantaged, hard-to-reach minority groups in the United States. We used data from the Integrated Health Outreach System Project collected in 2002 and 2003. Our sample included 386 participants randomly selected and interviewed face-to-face with a structured survey. We measured HRQL and examined personal and socioenvironmental correlates. Unadjusted and adjusted (multivariate) logistic regression models were used for data analyses. We found that border Mexican Americans living in colonias were of similar mental health status compared to the general population of the United States, but worse off in terms of physical health. Poor education and long-term residency in colonias were predictors of lower physical health. Women reported worse mental health than men. Length of time living in a colonia, co-morbidity status, and perceived problems with access to healthcare was associated with poorer mental health status. This study provides information for health professionals and policymakers and underscores the need to provide better preventive and medical services for underserved populations. Major findings indicate the need for additional research centered on further exploration of the impact of economic, cultural, and social influences on HRQL among severely disadvantaged populations.     

Impact of prior and current alcohol use on use of services by patients with depression and chronic medical illnesses.

OBJECTIVE. Alcohol use often co-occurs with other major chronic conditions, but its effect on health care utilization in this context is not understood. This study examines the impact of alcohol consumption on health care use by patients with chronic medical conditions or depression, or both. DATA SOURCES/STUDY SETTING. Data came from the Medical Outcomes Study, an observational study of patients from the offices of general medical providers and mental health specialists in three U.S. cities. STUDY DESIGN. Longitudinal data spanning four years for outpatient general medical visits and outpatient mental health visits were analyzed using a two-part model to assess the impact of alcohol use disorder, problem drinking, and current and past alcohol consumption on health care use by patients, controlling for patient demographics and health status. DATA COLLECTION/EXTRACTION METHODS. Data were collected from 2,546 adult patients with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), and/or current major depression or subthreshold depression using periodic, self-report surveys detailing health care utilization and health status information. PRINCIPAL FINDINGS. Current alcohol consumption increases outpatient doctor visits, and problems related to current drinking decrease outpatient mental health visits. CONCLUSIONS. Patterns of alcohol consumption have an impact on both mental health and overall health care use by patients with chronic medical conditions or depression.     

Stress, coping, and health: a comparison of Mexican immigrants, Mexican-Americans, and non-Hispanic whites

Mexican immigrants, Mexican-Americans, and non-Hispanic white Americans all face different stressors. Stress-coping strategies may vary for each group as well. We compared relationships among perceived stress, stress-coping strategies, and health-related quality of life (HRQL) in a rural sample of Mexican citizens living in the United States, Mexican-Americans, and non-Hispanic whites. Health-related quality of life and stress-coping styles varied among the three groups. Mexican citizens reported significantly better physical functioning than did non-Hispanic whites or Mexican-Americans. Mexican-Americans reported significantly better mental health functioning than did non-Hispanic whites or Mexican citizens. Mexican citizens were more likely to use positive reframing, denial, and religion, and less likely to use substance abuse and self-distraction, as stress-coping strategies. Stress-coping style may be a potentially modifiable predictor of physical and mental HRQL, and may account for part of the Hispanic health paradox.     

Prevalence and associated factors of cancer screening: why are so many older Mexican American women never screened?

OBJECTIVES: The aim of this study was to identify patterns of mammogram and Papanicolaou (Pap) screenings among Mexican American women ages 67 and over. METHODS: Data on 1,403 Mexican American women from the Hispanic Established Population for the Epidemiological Study of the Elderly, a cohort study of community-dwelling Mexican Americans ages 65 years or over from the southwestern United States, were analyzed. RESULTS: Mexican American women age 75 or older were less likely to ever have had breast or cervical screening than women ages 67 to 74, even controlling for sociodemographic, cultural, and selected health factors. Overall, fewer medical conditions and never having had a hysterectomy were found to be associated with a decreased chance of ever having had a mammogram or a Pap test. Women who lacked insurance coverage and had fewer doctor visits were less likely to ever have had a mammogram, whereas women with low education, low acculturation, and lower cognitive status scores were less likely to ever have had a Pap test. CONCLUSIONS: If these results withstand more detailed studies (e.g., with the addition of important variables such as awareness), better communication with health professional doctors and improvement of access to heath care services should increase rates of both mammogram and Pap screenings.     

Access of Hispanics to health care and cuts in services: a state-of-the-art overview

The most current research literature on the access of Hispanics to medical care is reviewed, and data from a 1982 national survey by Louis Harris and Associates on access to health care are presented to document current levels of access to health care of the Hispanic population. Through telephone interviews, 4,800 families were contacted, yielding a total sample of 6,610 persons. According to the survey's data, the ability of Hispanics to obtain health services is hampered by relatively low incomes, lack of health insurance coverage, and ties to a particular physician. However, Hispanics do not differ significantly from whites in their use of hospitals, physicians, or outpatient departments and emergency rooms. Hispanics are less satisfied than whites on a host of measures describing the most recent medical visit. These levels of dissatisfaction with the visit are similar to those of blacks. The recession and public care service cutbacks did not appear to result in a substantial reduction in the volume of medical care received by Hispanics and blacks. Still, the services available to minorities are viewed by them as less effective in meeting their needs in comparison with how whites view the services they receive. Further, the 1982 survey reveals particular difficulties and barriers for Hispanics in obtaining needed medical services. More than one-fifth of the Hispanic families had one or more significant problems in obtaining needed services.     

Coercive and voluntary referrals: How ethnic minority adults get into mental health treatment

Two hypotheses are typically invoked to examine the referral of adults into mental health care. The first is the clinical behavior hypothesis that suggests the psychiatric problem defines people as dangerous and risky. Accordingly, people with severe mental disorders are more likely to be coercively placed into mental health facilities. The second hypothesis suggests that people with less power are more likely than the powerful to be coercively placed in psychiatric care. We examine the extent to which these hypotheses are supported in a large urban community by investigating referrals into community mental health clinics that serve predominantly poor populations. The data set is unique because it includes four ethnic categories, whites, African Americans, Asian Americans, and Mexican Americans. The findings indicate that the clinical behavior hypothesis is applicable to whites and the stratification hypothesis is consistent with the data for African American, particularly African American men. The referral pattern for Mexican Americans and Asian Americans do not conform to the findings for whites and African Americans. It is likely that other sociocultural factors influence the referrals of these ethnic categories.     

Considerations in predicting mental health care use: Implications for managed care plans

Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.