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Articles   |    
Racial-Ethnic Disparities in Outpatient Mental Health Visits to U.S. Physicians, 1993–2008
Marc Manseau, M.D., M.P.H.; Brady G. Case, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200528
View Author and Article Information

Dr. Manseau is with the Public Psychiatry Fellowship, Department of Psychiatry, Columbia University, New York City (e-mail: mwm2110@columbia.edu). Dr. Case is with the Health Services Research Program, Emma Pendleton Bradley Hospital, East Providence, Rhode Island, and the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Some of the findings were presented as a poster at a National Institute of Mental Health conference, “From Disparities Research to Disparities Interventions: Lessons Learned and Opportunities for the Future of Behavioral Health Services,” Alexandria, Virginia, April 6–7, 2011.

Copyright © 2014 by the American Psychiatric Association

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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Table 1Number of outpatient mental health visits for racial-ethnic groups and visit prevalence ratios, by mental disorder
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a Numbers within categories do not necessarily sum to the total because of the exclusion of some diagnoses, such as bipolar disorder not otherwise specified, mood disorder not otherwise specified, and so forth.

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bStandard error ≥30% of estimate because of the small cell size (should be interpreted with caution)

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Table 2Number of outpatient mental health visits for racial-ethnic groups and visit prevalence ratios, by patient demographic characteristics and provider type
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a Reference group for the age comparisons within racial-ethnic group

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b Significantly different from the reference group on the basis of the 95% CI of absolute change

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c Reference group for the region comparisons within racial-ethnic group

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d Significantly different from Hispanics in the West but not between regions within the non-Hispanic black group

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e Significant differences between Hispanics in the West and between the reference region within the non-Hispanic black group

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Table 3Visit prevalence ratios (VPRs) for outpatient mental health visits, by provider type and time perioda
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a VPRs reflect the comparison with non-Hispanic whites.

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b Unweighted N. White non-Hispanic N not included

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c Significantly different from 1993–1996 on the basis of the 95% CI of absolute change

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Table 4Reported prevalence rates of mental disorders by race-ethnicity in national epidemiologic surveys
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a Ratios are calculated within published reports.

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b From the National Epidemiologic Survey on Alcohol and Related Conditions

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c From the National Comorbidity Survey

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d From the National Survey of American Life

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e From the National Comorbidity Survey Replication

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f From the Collaborative Psychiatric Epidemiology Surveys

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