Inequalities in mental health care and social services utilisation by immigrant women

Background: The basic assumption of public health policy forimmigrants is that they ought to have equal access to healthservices compared to other population groups In Dutch society.However, little research is done on the actual use of mentalhealth services by immigrants and literature seems to indicateinequalities in services utilisation by immigrant women. Methods:This study was conducted in Amsterdam, The Netherlands. Dataon service utilisation were drawn from patient registers andcame from care providers who were asked to keep up registrationfor some time to count the number of immigrant women referredto and in treatment. Results: Surinamese, Antillean, Turkishand Moroccan women made considerably less use of mental healthcare services than native-born women. On the other hand, immigrantwomen more frequently used social work facilities and womencrisis intervention centres. Overall, they consulted the latterorganizations nearly 1.5 times more frequently than mental healthcare services. The differences in service utilisation betweenthe four immigrant groups are also discussed. Conclusions: Thisstudy explores the reasons for the ethnic differences in serviceutilisation. It argues that cultural and supply factors arelargely responsible for the ethnic differences in use of mentalhealth services. The differential use of social services ismainly ascribed to the socioeconomic status of the women concerned.The results imply that a care policy may improve the accessibilityof mental health services for immigrant women. The most promisingmeasure is by employing more ethnic and bilingual care providers.     

POPULATION-AVERAGED AND CLUSTER-SPECIFIC MODELS FOR CLUSTERED ORDINAL RESPONSE DATA

We compare population-averaged and cluster-specific models for clustered ordinal data. We consider generalized estimating equations and constrained equations maximum likelihood estimation of population-averaged cumulative logit regression models, and mixed effects estimation of cluster-specific cumulative logit regression models. A previously reported relationship between population-averaged and cluster-specific parameters for the binary logistic link appears to hold for analogous parameters under the cumulative logit link. We address these issues in the context of data from two cross-over clinical trials.