title: Racial and ethnic differences in depressive subtypes and access to mental health care in the United States.
abstract: OBJECTIVE
  Racial and ethnic minorities in the U.S. underutilize mental health service for mood disorders. This study sought to identify depressive subtypes associated with low use of mental health services across racial and ethnic groups based on a large, nationally representative sample of adults in the U.S.
  
  
  METHODS
  Based on latent class analysis, we identified the latent profile of depressive symptoms among those who endorsed lifetime depressed mood or anhedonia in the 2001-2002 National Epidemiological Survey on Alcohol and Related Condition (302 Asian Americans; 8602 Whites; 2266 Blacks; 2254 Hispanics). Proportions and types of lifetime mental health service use across depressive symptom subtypes were assessed and compared across the racial and ethnic categories.
  
  
  RESULTS
  A four class model of depressive subtypes was examined across race and ethnicity ("mild," "cognitive," "psychosomatic," and "severe"). Asian Americans, blacks, and Hispanics with "severe" subtype of depression had significantly lower odds of mental health service use compared to whites with "severe" subtype of depression. While Asian Americans did not have higher proportion of "psychosomatic" subtype than other race and ethnic groups, Asian Americans with "cognitive" subtype of depression significantly underused mental health services compared to Asian Americans with "psychosomatic" subtype of depression (Odds ratio:0.34, 95% Confidence interval:0.13,0.91).
  
  
  CONCLUSIONS
  We were unable to account for heterogeneity of the subethnic group compositions based on country of origin and other socio-demographic factors.
  
  
  CONCLUSIONS
  A targeted outreach intervention to raise awareness among Asian Americans, blacks, and Hispanics with "severe" subtype and Asian Americans with "cognitive" subtype of depression may reduce disparity in mental health service utilization across racial and ethnic groups.
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States. Electronic address: sulee@jhsph.edu.
authors.forename: Su Yeon
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Medicine Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
authors.forename: Qian-li
authors.initials: QL
authors.lastname: Xue
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Spira
authors.affiliation: Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States.
authors.forename: Hochang B
authors.initials: HB
authors.lastname: Lee
mesh_terms: D000328:Adult; D001213:Asian / Q000523:psychology* / Q000706:statistics & numerical data; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000145:classification / Q000208:ethnology*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D001741:Black or African American