Assessing the Individual,Neighborhood,and Policy Predictors of Disparities in Mental Health Care

Abstract

This study assesses individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. Multilevel regression models are estimated using data from the Medical Expenditure Panel Surveys linked to area-level data sets. Compared with Whites, Blacks and Latinos live in neighborhoods with higher minority density, lower average education, and greater specialist mental health provider density, all of which predict lesser mental health care initiation. Neighborhood-level variables do not have differential effects on mental health care by race/ethnicity. Racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with Whites. Low rates of initiation in neighborhoods with a high density of specialists suggest that interventions to increase mental health care specialists, without a focus on treating racial/ethnic minorities, may not reduce access disparities.

Keywords

disparities mental health care multilevel modeling

Get full access to this article

View all access options for this article.

References

Afari

Schmaling

K. B.

Barnhart

Buchwald

(2001). Psychiatric comorbidity and functional status in adult patients with asthma. Journal of Clinical Psychology in Medical Settings, 8, 245-252.

Agency for Healthcare Research and Quality. (2012). MEPS HC-036BRR: 1996-2009 replicates for calculating variances file. Rockville, MD: Author.

Alegria

(2009). AcademyHealth 25th annual research meeting chair address: From a science of recommendation to a science of implementation. Health Services Research, 44, 5-14.

Alegria

Canino

Rios

Vera

Calderon

Rusch

Ortega

(2002). Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services, 53, 1547-1555.

Alegria

Lin

Chen

C. N.

Duan

Cook

Meng

X. L.

(2012). The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Services Research, 47, 1322-1344.

Alexopoulos

G. S.

Meyers

B. S.

Young

R. C.

Campbell

Silbersweig

Charlson

(1997). “Vascular depression” hypothesis. Archives of General Psychiatry, 54, 915-922.

Andersen

R. M.

(1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1-10.

Andersen

R. M.

Aday

L. A.

(1978). Access to medical care in the US: Realized and potential. Medical Care, 16, 533-546.

Arroll

Goodyear-Smith

Crengle

Gunn

Kerse

Fishman

. . . Hatcher

(2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine, 8, 348-353.

10.

Baicker

Chandra

Skinner

J. S.

Wennberg

J. E.

(2004). Who you are and where you live: How race and geography affect the treatment of Medicare beneficiaries. Health Affairs, Suppl Web Exclusives: VAR33-44.

11.

Bingenheimer

J. B.

Raudenbush

S. W.

(2004). Statistical and substantive inferences in public health: Issues in the application of multilevel models. Annual Review of Public Health, 25, 53-77.

12.

Blanco

Patel

Liu

Jiang

Lewis-Fernandez

Schmidt

. . . Olfson

(2007). National trends in ethnic disparities in mental health care. Medical Care, 45, 1012-1019.

13.

Blinder

(1973). Wage discrimination: Reduced form and structural elements. Journal of Human Resources, 8, 436-455.

14.

Braithwaite

R. L.

Lythcott

(1989). Community empowerment as a strategy for health promotion for Black and other minority populations. Journal of the American Medical Association, 261, 282-283.

15.

Breslau

Aguilar-Gaxiola

Kendler

K. S.

Williams

Kessler

R. C.

(2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36, 57-68.

16.

Breslau

Kendler

Gaxiola-Aguilar

Kessler

(2005). Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine, 35, 317-327.

17.

Burgess

D. J.

Ding

Hargreaves

van Ryn

Phelan

(2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal of Health Care for the Poor and Underserved, 3, 894-911.

18.

Chen

Vargas-Bustamante

(2011). Estimating the effects of immigration status on mental health care utilizations in the United States. Journal of Immigrant and Minority Health, 13, 671-680.

19.

Clarke

J. L.

Meiris

D. C.

(2007). Building bridges: Integrative solutions for managing complex comorbid conditions. American Journal of Medical Quality, 22, 5S-16S.

20.

Cohen

D. A.

Farley

T. A.

Mason

(2003). Why is poverty unhealthy? Social and physical mediators. Social Science & Medicine, 57, 1631-1641.

21.

Cook

B. L.

Doksum

Chen

C.-N.

Carle

Alegria

(2013). The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the US. Social Science & Medicine, 84, 102-109.

22.

Cook

B. L.

McGuire

Miranda

(2007). Measuring trends in mental health care disparities, 2000-2004. Psychiatric Services, 58, 1533-1539.

23.

Cook

B. L.

McGuire

T. G.

Zaslavsky

A. M.

(2012). Measuring racial/ethnic disparities in health care: Methods and practical issues. Health Services Research, 47, 1232-1254.

24.

Cook

B. L.

Zuvekas

Carson

Ferris Wayne

Vesper

McGuire

T. G.

(2014). Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Services Research, 49, 206-229.

25.

de Groot

Anderson

Freedland

K. E.

Clouse

R. E.

Lustman

P. J.

(2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine, 63, 619-630.

26.

Diez-Roux

A. V.

(1998). Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. American Journal of Public Health, 88, 216-222.

27.

Diez-Roux

A. V.

Mair

(2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186, 125-145.

28.

Dinwiddie

G. Y.

Gaskin

D. J.

Chan

K. S.

Norrington

McCleary

(2013). Residential segregation, geographic proximity and type of services used: Evidence for racial/ethnic disparities in mental health. Social Science & Medicine, 80, 67-75.

29.

Edlund

M. J.

Belin

T. R.

Tang

(2006). Geographic variation in alcohol, drug, and mental health services utilization: What are the sources of the variation? Journal of Mental Health Policy and Economics, 9(3), 123-132.

30.

Ferrari

Flora

Anderson

K. K.

Tuck

Archie

Kidd

McKenzie

(2015). The African, Caribbean and European (ACE) pathways to care study: A qualitative exploration of similarities and differences between African-origin, Caribbean-origin and European-origin groups in pathways to care for psychosis. BMJ Open, 5(1), e006562.

31.

Fiscella

Franks

Doescher

M. P.

Saver

B. G.

(2002). Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Medical Care, 40, 52-59.

32.

Fiscella

Williams

D. R.

(2004). Health disparities based on socioeconomic inequities: Implications for urban health care. Academic Medicine, 79, 1139-1147.

33.

Fisher

E. S.

Goodman

D. C.

Chandra

(2008). Regional and racial variation in health care among Medicare beneficiaries: A brief report of the Dartmouth Atlas Project. Lebanon, NH: Dartmouth Atlas of Health Care.

34.

Galea

Vlahov

(2005). Urban health: Evidence, challenges, and directions. Annual Review of Public Health, 26, 341-365.

35.

Garfield

R. L.

Damico

(2016). The coverage gap: Uninsured poor adults in states that do not expand Medicaid—An update. Washington, DC: Kaiser Family Foundation. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2016/01/8659-04-the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid.pdf

36.

Gaskin

D. J.

Dinwiddie

G. Y.

Chan

McCleary

(2012). Residential segregation and disparities in health care services utilization. Medical Care Research and Review, 69, 158-175.

37.

Jimenez

Cook

B. L.

Chen

C.-C.

Bartels

Alegria

(2013). Disparities in mental health service use among racial/ethnic minority elderly. Journal of the American Geriatrics Society, 61, 18-25.

38.

Keeler

E. B.

Manning

W. G.

Wells

K. B.

(1988). The demand for episodes of mental health services. Journal of Health Economics, 7, 369-392.

39.

Kessler

R. C.

Barker

P. R.

Colpe

L. J.

Epstein

J. F.

Gfroerer

J. C.

Hiripi

. . . Walters

E. E.

(2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184-189.

40.

Kirby

J. B.

Taliaferro

Zuvekas

S. H.

(2006). Explaining racial and ethnic disparities in health care. Medical Care, 44, I64-I72.

41.

Komaromy

Grumbach

Drake

Vranizan

Lurie

Keane

Bindman

A. B.

(1996). The role of Black and Hispanic physicians in providing health care for underserved populations. New England Journal of Medicine, 334, 1305-1310.

42.

Latalova

Kamaradova

Prasko

(2014). Perspectives on perceived stigma and self-stigma in adult male patients with depression. Neuropsychiatric Disease and Treatment, 10, 1399-1405.

43.

LaVeist

T. A.

(1992). The political empowerment and health status of African-Americans: Mapping a new territory. American Journal of Sociology, 97, 1080-1095.

44.

LaVeist

T. A.

Rolley

Diala

(2003). Prevalence and patterns of discrimination among U.S. health care consumers. International Journal of Health Services, 33, 331-344.

45.

Little

R. J. A.

Rubin

D. B.

(2002). Statistical analysis with missing data. Hoboken. NJ: Wiley.

46.

Matheson

F. I.

Moineddin

Dunn

J. R.

Creatore

M. I.

Gozdyra

Glazier

R. H.

(2006). Urban neighborhoods, chronic stress, gender and depression. Social Science & Medicine, 63, 2604-2616.

47.

McEwen

B. S.

(1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33-44.

48.

McGuire

T. G.

Alegria

Cook

B. L.

Wells

K. B.

Zaslavsky

A. M.

(2006). Implementing the Institute of Medicine definition of disparities: An application to mental health care. Health Services Research, 41, 1979-2005.

49.

Miranda

Bernal

Lau

Kohn

Hwang

LaFromboise

(2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113-142.

50.

Multum Information Services. (2009). Lexicon-drug product & disease listings, 2009. Retrieved from http://www.multum.com

51.

Oaxaca

(1973). Male-female wage differentials in urban labor markets. International Economic Review, 14, 693-709.

52.

Pescosolido

B. A.

(2006). Of pride and prejudice: The role of sociology and social networks in integrating the health sciences. Journal of Health and Social Behavior, 47, 189-208.

53.

Pescosolido

B. A.

Wright

Alegría

Vera

(1998). Social networks and patterns of use among the poor with mental health problems in Puerto Rico. Medical Care, 36, 1057-1072.

54.

Ponce

Hays

Cunningham

(2006). Linguistic disparities in health care access and health status among older adults. Journal of General Internal Medicine, 21, 786-791.

55.

Raudenbush

S. W.

Bryk

A. S.

(2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage.

56.

Reuland

D. S.

Cherrington

Watkins

G. S.

Bradford

D. W.

Blanco

R. A.

Gaynes

B. N.

(2009). Diagnostic accuracy of Spanish language depression-screening instruments. Annals of Family Medicine, 7, 455-462.

57.

Robert

S. A.

(1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25, 489-516.

58.

Rubin

D. B.

(1998). Multiple imputation of nonresponse in surveys. New York, NY: Wiley.

59.

Saloner

Carson

Cook

B. L.

(2014). Episodes of mental health treatment among a nationally representative sample of children and adolescents. Medical Care Research and Review, 7, 261-279.

60.

Schraufnagel

T. J.

Wagner

A. W.

Miranda

Roy-Byrne

P. P.

(2006). Treating minority patients with depression and anxiety: What does the evidence tell us? General Hospital Psychiatry, 28, 27-36.

61.

Schur

Feldman

(2001). Running in place: How job characteristics, immigrant status, and family structure keep Hispanics uninsured. New York, NY: Commonwealth Fund.

62.

Silver

Mulvey

Swanson

(2002). Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Social Science & Medicine, 55, 1457-1470.

63.

StataCorp. (2014). Stata Statistical Software: Release 14 [Computer software]. College Station, TX: Stata Corporation.

64.

Stokols

(1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10, 282-298.

65.

Stolk

Kaplan

Szwarc

(2014). Clinical use of the Kessler psychological distress scales with culturally diverse groups. International Journal of Methods in Psychiatric Research, 23, 161-183.

66.

Tansella

Micciolo

Biggeri

Bisoffi

Balestrieri

(1995). Episodes of care for first-ever psychiatric patients: A long-term case-register evaluation in a mainly urban area. British Journal of Psychiatry, 167, 220-227.

67.

Todorova

I. L.

Tucker

K. L.

Jimenez

M. P.

Lincoln

A. K.

Arevalo

Falcon

L. M.

(2013). Determinants of self-rated health and the role of acculturation: Implications for health inequalities. Ethnicity & Health, 18, 563-585.

68.

Truong

K. D.

(2006). A systematic review of relations between neighborhoods and mental health. Journal of Mental Health Policy and Economics, 9, 137-154.

69.

U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health (2nd ed.). Washington, DC: Author.

70.

Valencia-Garcia

(2012). Social capital, acculturation, mental health, and perceived access to services among Mexican American women. Journal of Consulting and Clinical Psychology, 80, 177-185.

71.

Weech-Maldonado

Morales

L. S.

Elliott

Spritzer

Marshall

Hays

R. D.

(2003). Race/ethnicity, language and patients’ assessments of care in Medicaid managed care. Health Services Research, 38, 789-808.

72.

Weich

Blanchard

Prince

Burton

Erens

B. O. B.

Sproston

(2002). Mental health and the built environment: Cross-sectional survey of individual and contextual risk factors for depression. British Journal of Psychiatry, 180, 428-433.

73.

Williams

D. R.

Collins

(2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116, 404-416.

74.

Williams

D. R.

Gonzalez

H. M.

Neighbors

Nesse

Abelson

J. M.

Sweetman

Jackson

J. S.

(2007). Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and non-Hispanic Whites: Results from the National Survey of American Life. Archives of General Psychiatry, 64, 305-315.

75.

Zuvekas

S. H.

(2001). Trends in mental health services use and spending, 1987-1996. Health Affairs (Millwood), 20, 214-224.

76.

Zuvekas

S. H.

Taliaferro

(2003). Pathways to access: Health insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999. Health Affairs (Millwood), 22, 139-153.