Do Racial and Ethnic Disparities in Mental Health Treatment Vary With Underlying Mental Health?

Abstract

A long line of studies document substantial and persistent racial and ethnic disparities in the use of mental health services. Many recent studies follow the Institute of Medicine’s definition of disparities, adjusting only for differences in health and mental health status across groups. However, controlling for mental health may mask important changes in the magnitudes of disparities at different levels of mental health need. We extend the previous literature by explicitly estimating how differences in treatment use across groups change at different levels of psychological distress. We used detailed data on sociodemographic characteristics, health insurance coverage, treatment, and the K6 psychological distress scale from the 2010 to 2015 Medical Expenditure Panel Survey to estimate nonlinear models of ambulatory and prescription drug mental health treatment. We find that in contrast to physical health treatment, Black–White and Hispanic–White disparities in any mental health treatment use widen with higher levels of psychological distress.

Racial differences in anxiety, depression, and quality of life in women with polycystic ovary syndrome

“…The impact of racial experiences on mental health cannot be understated. Unconscious bias and other race-related factors have been associated with differences in access to care, the use of treatment, and stress (12)(13)(14)(15)(16). It is possible that differences in mental health are also driven by cultural and systemic differences as well as structural racism (36).…”

“…Although racial disparities in phenotype and metabolic risk have been studied, there is no data on racial differences in emotional wellness in the PCOS population. It is important to consider the effect of racial disparities and differences on mental health, including the emerging evidence that racial experiences in minority populations can affect multiple aspects of mental health care, including distress due to anxiety, access to care, and the use of treatment (12)(13)(14)(15)(16). In the US general population, the lifetime prevalence of generalized anxiety disorder (GAD) is higher in White women (8.6%) compared with that in Black women (5.1%) (17).…”

Social Risk Factors and Racial and Ethnic Disparities in Health Care Resource Utilization Among Medicare Advantage Beneficiaries With Psychiatric Disorders

“…Similar to prior studies (e.g., Alegria et al, 2012; Biener & Zuvekas, 2021; Cook et al, 2017; Creedon & Cook, 2016; Mahmoudi & Jensen, 2012), we assessed disparities using the IOM Unequal Treatment framework (Institute of Medicine, 2002), which defines racial and ethnic health care disparities as all differences in health care use except for differences due to clinical need, clinical appropriateness, and patient preferences. To use this framework, we adjusted for allowable variables related to clinical need (Cook et al, 2012; McGuire et al, 2006) as represented by binary DSM-5 (American Psychiatric Association, 2013) diagnostic categories, binary suicidal ideation, CDMF Charlson comorbidity index score (Glasheen et al, 2019), RxRisk-V score (Sloan et al, 2003), and binary special needs population category.…”