National trends in ethnic disparities in mental health care.
OBJECTIVE
To compare trends in office-based treatment of mental disorders between Hispanics and non-Hispanics.


METHODS
Analysis of a nationally representative sample of visits to office-based physicians conducted between 1993 and 2002 (N = 251,905). Visits were grouped into 3 discrete time periods, 1993-1996, 1997-1999 and 2000-2002.


METHODS
Rate of diagnosis, type of mental health visit, type of treatment received (medication or psychotherapy), rate of psychotropic medications prescription, and specialty of the treating physician.


RESULTS
From 1993-1996 to 2000-2002, the proportion of office visits in which mental health care was provided decreased for Hispanics from 12.2% to 11.7% while it increased from 13.1% to 15.7% for non-Hispanics (P < 0.05). Visits with a diagnosis of mental disorder decreased from 5.2% to 5.1% in Hispanics but increased from 6.0% to 8.8% in non-Hispanics (P < 0.05). Visits resulting in prescription of a psychotropic medication decreased from 10.2% to 9.3% in Hispanics, while they increased from 10.2% to 12.5% in non-Hispanics (P < 0.05). Psychotherapy visits decreased from 2.4% to 1.3% in Hispanics (P < 0.05), whereas they remained constant (2.5%) in non-Hispanics. Visits to a psychiatrist decreased from 2.5% to 1.3% in Hispanics (P < 0.05), while they increased (nonsignificantly) from 3.1% to 3.5% for non-Hispanics. Most differences persisted after adjusting for age and insurance status.


CONCLUSIONS
From 1993 to 2002, there was an increase in mental health care disparities between Hispanics and non-Hispanics treated by office-based physicians. Improvement of the mental health care for Hispanics continues to be an important public health priority, with clear opportunities and challenges for health care policy-makers and practitioners.
Departments of Psychiatry, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. Cblanco@nyspi.cpmc.columbia.edu
Carlos
C
Blanco
Sapana R
SR
Patel
Linxu
L
Liu
Huiping
H
Jiang
Roberto
R
Lewis-Fernández
Andrew B
AB
Schmidt
Michael R
MR
Liebowitz
Mark
M
Olfson
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008511:Medicine; D001523:Mental Disorders / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D008605:Mental Health Services / Q000639:trends*; D008875:Middle Aged; D012959:Socioeconomic Factors; D013038:Specialization; D014481:United States
D014150:Antipsychotic Agents