This column examines racial-ethnic differences in the prevalence of serious mental illness and other mental disorders among disabled Medicare beneficiaries younger than 65. Although prevalence of serious mental illness and other mental disorders in this population is known to be high, little is known about the variation among racial-ethnic subgroups. Data are from Medicare-paid fee-for-service claims in 2004 for a 5% random sample of beneficiaries who qualified for coverage because of permanent disability (N=231,980).

Nearly one-third (N=71,914, 31%) of the sample had a diagnosed mental disorder during the year (ICD-9 codes CM 295–316). Diagnoses were lowest among blacks (25%) and Native Americans (7%). Rates among whites, Hispanics, and Asians were similar (30%–32% each).

Nearly one in five beneficiaries (N=43,360, 19%) had a diagnosed serious mental illness (major depressive disorder, bipolar disorder, or schizophrenia). Overall rates of serious mental illness were similar across racial-ethnic groups.

The racial-ethnic groups, however, showed different patterns of diagnosis when disorders were categorized into schizophrenia and affective disorders (major depressive disorder and bipolar disorder). Although affective disorders were more prevalent than schizophrenia among whites and Hispanics, the reverse was true for blacks, Asians, and Native Americans.

The high prevalence of serious mental illness across racial-ethnic categories among disabled Medicare beneficiaries highlights the importance of providing effective mental health care for this population. Because mental illness often co-occurs with general medical health problems, increased integration of mental health and general medical health care could improve the overall health of these beneficiaries (1).

Further research is needed to discover the social and other mechanisms underlying racial-ethnic differences.

Funding was received from the Substance Abuse and Mental Health Services Administration under contract 280-2003-00026 TO1. Judith L. Teich, M.S.W, served as the government project officer, and Jeffrey A. Buck, Ph.D., served as advisor.

The authors report no competing interests.