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Low Socioeconomic Status and Mental Health Care Use Among Respondents With Anxiety and Depression in the NCS-R

Dr. Roy-Byrne and Dr. Joesch are affiliated with the Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave., Box 359911, Seattle, WA 98104-2499 (e-mail: roybyrne{at}u.washington.edu). They are also with the Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, Harborview Medical Center. Dr. Wang is with the Office of the Director, National Institute of Mental Health, Bethesda, Maryland. Dr. Kessler is with the Department of Health Care Policy, Harvard Medical School, Boston.

OBJECTIVE: This study sought to determine whether previously reported poor outcomes among patients of low socioeconomic status who have depression and anxiety could result from not receiving mental health treatment or from receiving minimally adequate treatment. METHODS: The study sample consisted of 1,772 participants in the National Comorbidity Survey Replication (NCS-R) who met criteria for a mood or anxiety disorder. Bivariate and multivariate logistic regression analyses were used to examine associations between education, income, and assets and receipt of treatment and quality of treatment (minimally adequate treatment) for mood and anxiety disorders in sectors with the capacity to deliver evidence-based treatments (the general medical and mental health specialty sectors). Multivariate analyses controlled for age, gender, race-ethnicity, marital status, health insurance, and urbanicity. RESULTS: Age, gender, marital status, and race-ethnicity were strong and fairly consistent predictors of mental health services use, with some modest variations by sector. In contrast, in bivariate and multivariate analyses, education, income, and assets were minimally related to use of mental health care and to receipt of minimally adequate care in both general medical and mental health specialty sectors. CONCLUSIONS: Socioeconomic status does not appear to play a major role in determining aspects of treatment for depression and anxiety disorders. Poor outcomes of depressed and anxious patients with low socioeconomic status may be due to differences in quality of care beyond the minimally adequate level assessed in this study or to factors unrelated to quality of care that could counteract effective treatments, such as the presence of ongoing chronic stress.

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