Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites.
OBJECTIVE
The authors investigated whether there are disparities in the rates of specialty mental health care for Latinos and African Americans compared with non-Latino whites in the United States.


METHODS
Data were analyzed from the 1990-1992 National Comorbidity Survey, which surveyed a probability sample of 8,098 English-speaking respondents aged 15 to 54 years. Respondents self-identified their race or ethnicity, yielding a sample of 695 Latinos, 987 African Americans, and 6,026 non-Latino whites. Data on demographic characteristics, insurance status, psychiatric morbidity, whether the respondent lived in an urban or a rural area, geographic location, income, and use of mental health services were determined for each ethnic or racial group. Logistic regression analyses were used to examine the associations between ethnic or racial group and use of specialty services, with relevant covariates adjusted for.


RESULTS
Significant differences between ethnic groups were found in demographic characteristics, geographic location, zone of residence, insurance status, income, wealth, and use of mental health services. The results indicated that poor Latinos (family income of less than $15,000) have lower access to specialty care than poor non-Latino whites. African Americans who were not classified as poor were less likely to receive specialty care than their white counterparts, even after adjustment for demographic characteristics, insurance status, and psychiatric morbidity.


CONCLUSIONS
To understand ethnic or racial disparities in specialty care, the effects of ethnicity or race should be analyzed in combination with variables related to poverty status and environmental context. Further research needs to address the complex construct of social position in order to bridge the gap in unmet need in specialty care.
Alegría
Margarita
M
Center for Multicultural Mental Health Research, Cambridge Health Alliance, 120 Beacon Street Fourth Floor, Somerville, MA 02143, USA. malegria@charesearch.org
Canino
Glorisa
G
Ríos
Ruth
R
Vera
Mildred
M
Calderón
José
J
Rusch
Dana
D
Ortega
Alexander N
AN
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011570:Psychiatry; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology*