Gaps in service utilization by Mexican Americans with mental health problems.
OBJECTIVE
The purpose of this study was to ascertain the degree of underutilization of services for mental health problems among urban and rural Mexican American adults.


METHODS
A probability sample (N = 3,012) was used to represent the Mexican American population of Fresno County, California, and face-to-face interviews were conducted with the use of the Composite International Diagnostic Interview. Bivariate and multivariate analyses were used to analyze the data on diagnosis and service utilization.


RESULTS
Among the respondents with DSM-III-R-defined disorders, only about one-fourth had used a single service or a combination of services in the past 12 months, and Mexican immigrants had a utilization rate which was only two-fifths of that of Mexican Americans born in the United States. Overall use of mental health care providers by persons with diagnosed mental disorders was 8.8%, use of providers in the general medical sector was 18.4%, use of other professionals was 12.7%, and use of informal providers was only 3.1%. According to logistic regression analyses, factors associated with utilization of mental health services included female sex, higher educational attainment, unemployment, and comorbidity.


CONCLUSIONS
Immigrants are unlikely to use mental health services, even when they have a recent disorder, but may use general practitioners, which raises questions about the appropriateness, accessibility, and cost-effectiveness of mental health care for this population. Several competing hypotheses about the reasons for low utilization of services need to be examined in future research.
Vega
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University of Texas, San Antonio 78207, USA. wvega@utsa.edu
Kolody
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Aguilar-Gaxiola
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Catalano
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D000328:Adult; D002140:California / Q000453:epidemiology; D003156:Community Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D017058:Mexican Americans / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012494:Sampling Studies