title: Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care.
abstract: This study assesses individual- and area-level predictors of racial/ethnic disparities in mental health care episodes for adults with psychiatric illness. Multilevel regression models are estimated using data from the Medical Expenditure Panel Surveys linked to area-level data sets. Compared with Whites, Blacks and Latinos live in neighborhoods with higher minority density, lower average education, and greater specialist mental health provider density, all of which predict lesser mental health care initiation. Neighborhood-level variables do not have differential effects on mental health care by race/ethnicity. Racial/ethnic disparities arise because minorities are more likely to live in neighborhoods where treatment initiation is low, rather than because of a differential influence of neighborhood disadvantage on treatment initiation for minorities compared with Whites. Low rates of initiation in neighborhoods with a high density of specialists suggest that interventions to increase mental health care specialists, without a focus on treating racial/ethnic minorities, may not reduce access disparities.
authors.affiliation: 1 Harvard Medical School, Boston, MA, USA.|2 Cambridge Health Alliance, Cambridge, MA, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Cook
authors.affiliation: 3 Agency for Healthcare Research and Quality, Rockville, MD, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Zuvekas
authors.affiliation: 4 University of Maryland, College Park, MD, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: 1 Harvard Medical School, Boston, MA, USA.|2 Cambridge Health Alliance, Cambridge, MA, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Progovac
authors.affiliation: 5 Northeastern University, Boston, MA, USA.
authors.forename: Alisa K
authors.initials: AK
authors.lastname: Lincoln
mesh_terms: D000328:Adult; D000368:Aged; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: disparities; mental health care; multilevel modeling