Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Abstract

Objective Although studies have shown disparities between black and white populations in service utilization for mental disorders, little information exists on whether such disparities apply equally across disorders. The objective of this study was to examine racial differences in lifetime prevalence of service utilization for mood and anxiety disorders and for alcohol and drug use disorders, with controls for predisposing, enabling, and need-for-service variables unequally distributed between racial-ethnic groups. Methods Data were from a face-to-face epidemiologic survey of 32,752 non-Hispanic white or black adults ages 18 and older residing in households and group quarters in the United States. Main outcome measures were treatment for mood, anxiety, and alcohol and drug use disorders. Results White adults were consistently more likely than black adults to have had treatment for mood disorders (odds ratio [OR]=2.16, 95% confidence interval [CI]=1.80–2.59) and anxiety disorders (OR=1.77, 95% CI=1.43–2.19) after adjustment for predisposing and enabling factors and need for service (severity of disorder). In contrast no evidence of lower service utilization for treatment of alcohol use disorders emerged among black respondents (OR=.87, 95% CI .69–1.10). Moreover, white respondents with drug use disorders were significantly less likely than black respondents to receive treatment for a drug problem (OR=.64, 95% CI=.47–.88). Conclusions Differences in treatment between black and white adults depended on the specific disorder and type of treatment considered. Prevention and intervention strategies should address disorder-specific disparities in services received.

Mental Health Service Use by Persons of Asian Ancestry WithDSM-IVMental Disorders in the United States

“…As described by Keyes and others (31), variables that we controlled for the regression model were selected from the Andersen model of health services utilization (32,33). Those confounders consisted of predisposing factors (sex and age) and enabling factors (income, education, marital status, and current insurance status).…”

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

“…Those with alcohol dependence before age 30 were unlikely to receive treatment [311], as were Blacks [248], Hispanics [248,312], and women [313,314]. Substance and psychiatric comorbidity predicted treatment [314-317], and equalized black/white differences [318,319]. Medical comorbidity [320], including injury [321] also predicted alcohol treatment.…”

“…Longer duration and comorbidity predicted treatment [328,329]. Nonwhites were more likely than whites to perceive a need for treatment [328] and to receive treatment [318,319,326,327], often from 12-step groups or clergy [326]. Again, attitudinal barriers were important: participants perceiving a need for treatment were more likely to use services than others, while among participants perceiving a need, those with pessimistic attitudes about treatment outcomes were less likely to use services [330], supporting the need for public education.…”

“We Pride Ourselves on Being Strong…and Able to Bear a lot”: Examining the Socio-Cultural and Historical Context of Black Americans’ Experiences with Depression and Help-Seeking

“…Most of the diagnosable cases of MDD among Black Americans go untreated and tend to have more impairing effects (Wang et al, 2005;Williams et al, 2007). In terms of professional help-seeking for depression and other mental health problems, research has shown that Black Americans utilize mental health services at a rate below that of Whites (Alegría, Chatterji et al, 2008;Keyes et al, 2008;Williams et al, 2007), even when they have insurance. Despite efforts through the Affordable Health Care Act to increase access to care and establish mental health parity, the overall gap in service use between Blacks and Whites is expected to persist (Alegria, Lin et al, 2012).…”