Racial-Ethnic Disparities in Outpatient Mental Health Visits to U.S. Physicians, 1993–2008

Marc W. Manseau · Brady G. Case

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Mental Health Treatment and Access Health disparities and outcomes Racial and Ethnic Identity Research

Abstract

OBJECTIVE: The purpose of this study was to examine racial-ethnic differences in use of mental health treatment for a comprehensive range of specific disorders over time. METHODS: Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were used to examine adult outpatient mental health visits to U.S. physicians from 1993 to 2008 (N=754,497). Annual visit prevalence for three racial-ethnic groups was estimated as the number of visits divided by the group's U.S. population size. Visit prevalence ratios (VPRs) were calculated as the minority group's prevalence divided by the non-Hispanic white prevalence. Analyses were stratified by diagnosis, physician type, patient characteristics, and year. RESULTS: VPRs for any disorder were .60 (95% confidence interval [CI]=.52-.68) for non-Hispanic blacks and .58 (CI=.50-.67) for Hispanics. Non-Hispanic blacks were treated markedly less frequently than whites for obsessive-compulsive, generalized anxiety, attention-deficit hyperactivity, personality, panic, and nicotine use disorders but more frequently for psychotic disorders. Hispanics were treated far less frequently than whites for bipolar I, impulse control, autism spectrum, personality, obsessive-compulsive, and nicotine use disorders but more frequently for drug use disorders. Racial-ethnic differences in visits to psychiatrists were generally greater than for visits to nonpsychiatrists. Differences declined with increasing patient age and appear to have widened over time. CONCLUSIONS: Racial-ethnic differences in receipt of outpatient mental health treatment from U.S. physicians varied substantially by disorder, provider type, and patient age. Most differences were large and did not show improvement over time.

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References

2003Unequal treatment: confronting racial and ethnic disparities in health care 2003Health Care Disparities 2005Twelve-Month Use of Mental Health Services in the United States 2005Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders in the National Comorbidity Survey Replication 2007Prevalence and Distribution of Major Depressive Disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites 2008Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States 2001Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care 2002Mental Health Care for Latinos: Inequalities in Use of Specialty Mental Health Services Among Latinos, African Americans, and Non-Latino Whites

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