Race and Beliefs About Mental Health Treatment Among Anxious Primary Care Patients

Hunt, Justin; Sullivan, Greer; Chavira, Denise A.; Stein, Murray B.; Craske, Michelle G.; Golinelli, Daniela; Roy‐Byrne, Peter; Sherbourne, Cathy D.

doi:10.1097/nmd.0b013e3182845ad8

Cited by 22 publications

(11 citation statements)

References 43 publications

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“…However, our findings are well in line with other studies that have found that ethnic minorities are underrepresented in mental health services across Britain, 7,8 as well as in the USA. [20][21][22][23][24] Overall, our findings are partially consistent with those of a study by Manseau & Case 24 who found that non-Hispanic Black individuals were treated markedly less frequently than their White counterparts for anxiety disorders -particularly OCD -as well as for dysthymia, personality disorders, nicotine use disorder, and attention-deficit hyperactive disorder in adult out-patient physician offices and hospital-based clinics in the USA. However, comparisons between the two studies are difficult because of context differences (i.e.…”

Section: Main Findingssupporting

confidence: 81%

“…There is currently little research in this field. As pointed out by Hunt et al, 23 it is critical to determine whether there are differences in beliefs about mental healthcare and treatment preferences across different ethnic groups. If these differences exist, they could partially explain the gap in care between minority and non-minority populations.…”

Section: Discussionmentioning

confidence: 99%

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Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

et al. 2015

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Obsessive-compulsive disorder (OCD) has similar prevalence rates across the World.1,2 Within Western countries, including the UK, the prevalence of OCD has been shown to be roughly consistent across ethnic groups. For example, the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study 3,4 examined the prevalence of mental disorders across adult British White, Black Caribbean, Indian, Pakistani, Bangladeshi and Irish ethnic groups. A similar point prevalence of OCD of around 1% was found across all ethnicities. Heyman et al 5 conducted a nationwide (UK) epidemiological survey to establish the prevalence of OCD in young people aged 5-15 (n410 000) and reported a significantly greater proportion of children from ethnic minorities among those with OCD (24%) compared with healthy controls (8.8%) and psychiatric controls (7.4%). Given the similar, if not higher, prevalence of OCD across ethnic groups in Britain [3][4][5] and elsewhere, 6 a proportional representation of different ethnic groups would be expected in mental health services. However, there is substantial evidence to indicate that patients from ethnic minorities, both children 7 and adults, 8 tend to be underrepresented in mental health services in Britain, although data specifically relating to OCD is lacking. Research conducted in North America suggests that patients with OCD from ethnic minorities are underrepresented in clinical trials. Williams et al 9 reviewed 21 randomised controlled trials of OCD conducted in North America and found that ethnic minorities were seriously underrepresented in such studies (91% of participants were White). As OCD has rarely been studied separately, there is little data relating specifically to ethnic inequalities in access to clinical services of this major, yet treatable, psychiatric disorder. The overall aim of the present study was to explore whether individuals with OCD from ethnic minorities are underrepresented in secondary and tertiary clinical services within a large mental health trust in South London, relative to the ethnic composition of the corresponding catchment area. We also aimed to determine whether ethnic inequalities, if found, are restricted to a particular age group (children v. adults) or type of clinical service (community mental health clinics v. specialist clinics) or specific to OCD (compared with depression). Method Study settingThe South London and Maudsley (SLaM) NHS Foundation Trust is Europe's largest specialist mental healthcare trust. It serves a population of approximately 1.2 million residents of four South London boroughs: Lambeth, Southwark, Lewisham and Croydon. A proportion of SLaM services are tertiary care national referral units, 10 including three national specialist clinics for OCD: the Clinic for Young People with OCD and Related Disorders (Maudsley Hospital; child and adolescent out-and in-patients), the Centre for Anxiety Disorders and Trauma (CADAT; Maudsley Hospital, adult out-patients) and the Anxiety Disorders Residential Unit (ADRU; Bethlem Royal H...

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Section: Main Findingssupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

et al. 2015

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“…Differences were found only between Hispanics and Native Americans, and these were small in magnitude. Therefore, the authors concluded that differences in illness beliefs and treatment preferences may not fully explain the large, persistent ethnic disparities in mental health care and that other crucial barriers to quality care exist [18]. By contrast, other research conducted in the UK revealed different illness perceptions of depression between Black African and White British women, and it was suggested that illness perceptions could help explain the lower detection rates of depression in ethnic minority groups [19].…”

Section: Introductionmentioning

confidence: 69%

“…Hunt et al [18] compared beliefs about mental illness and treatment preferences between African Americans, Hispanics, Asian Americans, Native Americans, and White Americans with anxiety disorders. Differences were found only between Hispanics and Native Americans, and these were small in magnitude.…”

Section: Introductionmentioning

confidence: 99%

Illness perception, help-seeking attitudes, and knowledge related to obsessive–compulsive disorder across different ethnic groups: a community survey

Cruz

Kolvenbach

Vidal‐Ribas

et al. 2015

Soc Psychiatry Psychiatr Epidemiol

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“…There is some evidence that certain cultures prefer complementary and alternative medicine (i.e. herbal remedies) to allopathic pharmacotherapy for treatment of depression or anxiety 42,43 . In addition, other factors such as immigration status 44 , language preference 23 , socioeconomic status 11 , and having subsidized insurance 23 have all been related to whether a patient is diagnosed with a mental health condition and subsequently prescribed medication.…”

Section: Discussionmentioning

confidence: 99%

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Coleman¹,

Stewart²,

Waitzfelder³

et al. 2016

106

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Objective The objective of this study is to characterize racial/ethnic variation in mental health diagnoses and treatments in large not-for-profit healthcare systems. Method Participating systems were 11 private, not-for-profit healthcare organizations constituting the Mental Health Research Network (MHRN) and had a combined 7,523,956 patients aged 18 years or older, who received care during 2011. Rates of diagnoses, psychotropic medications, and formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all healthcare settings. Results Of the 7,523,956 patients in the study, 1,169,993 (15.6%) received a mental health diagnosis in 2011. This varied significantly by race/ethnicity with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a mental health diagnosis, 73% (n = 850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial/ethnic groups (range 61.5% to 74.0%) to receive medication. In contrast, only 34% of patients with a mental health diagnosis (n = 548,837) received formal psychotherapy. Racial/ethnic differences were most pronounced for depression and schizophrenia where non-Hispanic blacks were 20% more likely to receive formal psychotherapy for their depression and 2.64 times more likely to receive formal psychotherapy for their schizophrenia when compared to whites. Conclusions There were significant racial/ethnic differences in diagnosis and treatment of mental health conditions across 11 U.S. healthcare systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.

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Race and Beliefs About Mental Health Treatment Among Anxious Primary Care Patients

Cited by 22 publications

References 43 publications

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive–compulsive disorder

Illness perception, help-seeking attitudes, and knowledge related to obsessive–compulsive disorder across different ethnic groups: a community survey

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

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