Racial-Ethnic Disparities in Outpatient Mental Health Care in the United States
Abstract
Objective:
Methods:
Results:
Conclusions:
HIGHLIGHTS
Methods
Data Sources
Study Samples
Mental Health Service Outcomes
Mental Health Conditions and Other Characteristics
Statistical Analysis
Results
Annual Rates of Outpatient Mental Health Care Utilization
Receipt of outpatient mental health care per 100 persons | White-Black comparisonb | White-Hispanic comparisonb | Black-Hispanic comparisonb | ||||||
---|---|---|---|---|---|---|---|---|---|
Characteristic | White | Black | Hispanic | Difference (percentage points) | 95% CI | Difference (percentage points) | 95% CI | Difference (percentage points) | 95% CI |
Total (White, N=29,126; Black, N=7,965; Hispanic, N=12,640) | 25.3 | 12.2 | 11.4 | 12.7 | 11.4, 14.0 | 13.5 | 12.3, 14.7 | .8 | −.7, 2.2 |
Male | |||||||||
Total (White, N=14,164; Black, N=3,524; Hispanic, N=5,994) | 19.4 | 10.9 | 9.2 | 8.2 | 6.4, 10.0 | 10.0 | 8.5, 11.4 | 1.8 | .2, 3.8 |
Ages 4–17 (White, N=2,390; Black, N=835; Hispanic, N=1,862) | 17.9 | 12.3 | 11.0 | 6.2 | 2.3, 10.0 | 7.7 | 5.0, 10.5 | 1.5 | −2.6, 5.7 |
Ages 18–44 (White, N=4,242; Black, N=1,184; Hispanic, N=2,321) | 18.6 | 9.2 | 6.4 | 8.4 | 6.0, 10.8 | 11.3 | 9.2, 13.3 | 2.9 | .4, 5.4 |
Ages 45–64 (White, N=3,955; Black, N=931; Hispanic, N=1,305) | 19.6 | 12.5 | 9.4 | 7.5 | 4.5, 10.4 | 10.8 | 8.0, 13.5 | 3.3 | .2, 6.4 |
Ages ≥65 (White, N=3,577; Black, N=574; Hispanic, N=506) | 21.8 | 10.7 | 18.8 | 13.1 | 9.7, 16.6 | 6.5 | .9, 12.1 | −6.6 | −12.6, .6 |
Female | |||||||||
Total (White, N=14,962; Black, N=4,441; Hispanic, N=6,646) | 30.9 | 13.2 | 13.6 | 17.1 | 15.6, 18.7 | 16.8 | 15.1, 18.5 | −.3 | −2.0, 1.3 |
Ages 4–17 (White, N=2,195; Black, N=851; Hispanic, N=1,736) | 16.5 | 7.7 | 7.9 | 7.8 | 5.0, 10.5 | 8.2 | 5.5, 10.9 | .4 | −2.3, 3.2 |
Ages 18–44 (White, N=4,330; Black, N=1,509; Hispanic, N=2,657) | 30.0 | 12.0 | 13.3 | 16.0 | 13.2, 18.8 | 15.2 | 12.6, 17.8 | −.8 | −3.3, 1.7 |
Ages 45–64 (White, N=4,336; Black, N=1,263; Hispanic, N=1,538) | 35.9 | 17.6 | 17.6 | 20.3 | 17.4, 23.1 | 20.7 | 17.3, 24.0 | .4 | −3.2, 4.0 |
Ages ≥65 (White, N=4,101; Black, N=818; Hispanic, N=715) | 34.8 | 16.3 | 22.3 | 20.7 | 17.4, 24.0 | 16.4 | 12.4, 20.3 | −4.3 | −9.1, .4 |
Socioeconomic Mediation of Racial-Ethnic Differences in Outpatient Care
Unadjusted | Partially adjustedb | Fully adjustedc | ||||
---|---|---|---|---|---|---|
Characteristic | Difference (percentage points) | 95% CI | Difference (percentage points) | 95% CI | Difference (percentage points) | 95% CI |
Non-Hispanic Black (reference: non-Hispanic White) | −13.1 | −14.5, −11.7 | −12.6 | −13.9, −11.3 | −12.0 | −13.3, −10.6 |
Hispanic (reference: non-Hispanic White) | −13.8 | −15.1, −12.6 | −12.8 | −14.0, −11.6 | −11.0 | −12.3, −9.7 |
Characteristics of People Using Outpatient Mental Health Care
Outpatient mental health care (%) | White-Black comparison | White-Hispanic comparison | Black-Hispanic comparison | ||||||
---|---|---|---|---|---|---|---|---|---|
Characteristic | White (N=7,731) | Black (N=1,069) | Hispanic (N=1,497) | Difference (percentage points) | p | Difference (percentage points) | p | Difference (percentage points) | p |
Age in years | |||||||||
4–17 | 10.6 | 17.7 | 22.0 | −7.1 | <.001 | −11.4 | <.001 | −4.3 | .060 |
18–44 | 32.2 | 34.9 | 37.3 | −2.7 | .260 | −5.2 | .020 | −2.5 | .400 |
45–64 | 32.1 | 32.5 | 25.6 | −.4 | .870 | 6.5 | <.001 | 6.9 | .010 |
≥65 | 25.2 | 15.0 | 15.1 | 10.2 | <.001 | 10.1 | <.001 | −.2 | .940 |
Sex | |||||||||
Male | 37.8 | 42.0 | 40.1 | −4.2 | .050 | −2.3 | .240 | 1.9 | .500 |
Female | 62.2 | 58.0 | 59.9 | 4.2 | .050 | 2.3 | .240 | −1.9 | .500 |
Marital status | |||||||||
Married | 44.2 | 22.9 | 33.2 | 21.3 | <.001 | 11.0 | <.001 | −10.3 | <.001 |
Separated, divorced, or widowed | 24.9 | 24.0 | 20.5 | .8 | .670 | 4.4 | .010 | 3.5 | .140 |
Single | 22.8 | 38.1 | 28.4 | −15.3 | <.001 | −5.7 | .002 | 9.7 | .001 |
Highest education level | |||||||||
No high school diploma or GED | 17.8 | 32.0 | 40.6 | −14.2 | <.001 | −22.8 | <.001 | −8.6 | .004 |
High school diploma or GED | 23.6 | 25.7 | 21.6 | −2.1 | .320 | 2.0 | .240 | 4.0 | .110 |
Some college | 26.1 | 24.3 | 20.9 | 1.7 | .410 | 5.2 | .003 | 3.5 | .190 |
Bachelor’s degree | 32.5 | 18.0 | 16.9 | 14.5 | <.001 | 15.6 | <.001 | 1.1 | .620 |
Family income | |||||||||
Poor or near poverty | 13.9 | 35.5 | 23.3 | −21.6 | <.001 | −9.3 | <.001 | 12.2 | <.001 |
Low | 11.1 | 17.3 | 15.3 | −6.2 | .002 | −4.1 | .003 | 2.0 | .380 |
Middle | 27.1 | 24.6 | 29.9 | 2.6 | .240 | −2.7 | .180 | −5.3 | .060 |
High | 47.8 | 22.6 | 31.6 | 25.2 | <.001 | 16.2 | <.001 | −9.0 | .005 |
Health insurance | |||||||||
Private, <65 years | 57.2 | 41.1 | 52.4 | 16.1 | <.001 | 4.9 | .040 | −11.3 | .001 |
Public, <65 years | 15.8 | 41.3 | 28.5 | −25.5 | <.001 | −12.7 | <.001 | 12.8 | <.001 |
Uninsured | 1.8 | 2.6 | 4.1 | −.8 | .250 | −2.2 | .002 | −1.4 | .140 |
Medicare only, ≥65 years | 9.5 | 3.6 | 5.2 | 5.9 | <.001 | 4.4 | <.001 | −1.5 | .130 |
Medicare and public, ≥65 years | 12.6 | 6.0 | 3.0 | 6.6 | <.001 | 9.6 | <.001 | 3.0 | .004 |
Medicare and private, ≥65 years | 3.0 | 5.3 | 6.9 | −2.3 | .005 | −3.9 | <.001 | −1.5 | .210 |
Employment status | |||||||||
Employed | 48.5 | 38.0 | 40.8 | 10.5 | <.001 | 7.8 | <.001 | −2.7 | .310 |
Not employed, <65 years | 30.5 | 49.0 | 45.4 | −18.5 | <.001 | −15.0 | <.001 | 3.6 | .210 |
Not employed, ≥65 years | 21.0 | 12.9 | 13.8 | 8.0 | <.001 | 7.2 | <.001 | −.8 | .640 |
Treated mental health conditionb | |||||||||
Any mood disorder | 38.1 | 33.9 | 30.7 | 4.2 | .060 | 7.4 | <.001 | 3.3 | .190 |
Depression | 34.3 | 27.7 | 28.1 | 6.6 | .004 | 6.2 | .001 | −.4 | .870 |
Anxiety | 41.5 | 28.5 | 34.4 | 13.0 | <.001 | 7.0 | .001 | −6.0 | .020 |
Trauma- or stress-related disorder | 7.6 | 10.4 | 7.2 | −2.8 | .030 | .4 | .670 | 3.2 | .040 |
ADHD or disruptive behavior disorder | 14.0 | 16.4 | 17.3 | −2.4 | .200 | −3.3 | .080 | −.9 | .730 |
Other mental health disorder | 43.3 | 48.3 | 44.4 | −5.0 | .030 | −1.1 | .590 | 3.9 | .120 |
Mental health–related condition | 6.9 | 10.4 | 8.1 | −3.5 | .020 | −1.2 | .330 | 2.3 | .210 |
Perceived mental health status | |||||||||
Excellent | 16.2 | 14.7 | 17.8 | 1.4 | .360 | −1.6 | .290 | −3.1 | .120 |
Very good | 30.0 | 21.2 | 24.7 | 8.7 | <.001 | 5.2 | <.001 | −3.5 | .150 |
Good | 35.0 | 35.8 | 32.9 | −.8 | .660 | 2.1 | .260 | 2.9 | .240 |
Fair or poor | 18.9 | 28.2 | 24.5 | −9.3 | <.001 | −5.7 | <.001 | 3.7 | .180 |
Psychotropic Medications and Psychotherapy
% using mental health service | Adjusted White-Black comparisonb | Adjusted White-Hispanic comparisonb | Adjusted Black-Hispanic comparisonb | ||||||
---|---|---|---|---|---|---|---|---|---|
Mental health condition | White | Black | Hispanic | Difference (percentage points) | p | Difference (percentage points) | p | Difference (percentage points) | p |
Any (White, N=7,731; Black, N=1,069; Hispanic, N=1,497) | |||||||||
Any psychotropic medication | 83.4 | 69.9 | 68.4 | 12.5 | <.001 | 12.3 | <.001 | .2 | .950 |
Any psychotherapy | 33.3 | 47.7 | 42.6 | −9.7 | <.001 | −3.7 | .040 | −6.0 | .020 |
Both | 21.4 | 24.3 | 22.4 | .4 | .800 | 2.0 | .200 | −1.5 | .490 |
Any mood disorder (White, N=3,049; Black, N=366; Hispanic, N=504) | |||||||||
Any psychotropic medication | 94.3 | 84.9 | 88.5 | 8.3 | .005 | 4.7 | .020 | 3.6 | .320 |
Any psychotherapy | 39.8 | 60.3 | 50.5 | −15.1 | <.001 | −4.7 | .150 | −10.5 | .020 |
Both | 34.9 | 46.3 | 40.7 | −7.1 | .040 | −1.0 | .780 | −6.1 | .210 |
Depressive disorder (White, N=2,762; Black, N=296; Hispanic, N=460) | |||||||||
Any psychotropic medication | 93.8 | 84.8 | 89.0 | 7.9 | .020 | 3.7 | .070 | 4.2 | .270 |
Any psychotherapy | 37.9 | 60.8 | 47.9 | −17.3 | <.001 | −4.3 | .200 | −13.0 | .006 |
Both | 32.6 | 46.2 | 38.8 | −9.3 | .010 | −1.7 | .620 | −7.6 | .140 |
Anxiety disorder (White, N=3,177; Black, N=315; Hispanic, N=520) | |||||||||
Any psychotropic medication | 92.1 | 84.5 | 81.7 | 8.3 | .020 | 8.6 | <.001 | −.3 | .950 |
Any psychotherapy | 36.5 | 47.4 | 42.6 | −8.3 | .030 | −.2 | .960 | −8.2 | .060 |
Both | 29.9 | 35.3 | 31.0 | −2.3 | .530 | 3.3 | .260 | −5.6 | .210 |
Trauma- or stress-related disorder (White, N=610; Black, N=103; Hispanic, N=107) | |||||||||
Any psychotropic medication | 68.6 | 55.2 | 50.3 | 12.8 | .040 | 16.1 | .008 | −3.2 | .670 |
Any psychotherapy | 65.2 | 70.4 | 61.5 | −3.0 | .610 | 8.1 | .140 | −11.1 | .120 |
Both | 42.2 | 36.3 | 33.9 | 7.0 | .180 | 9.3 | .090 | −2.3 | .740 |
ADHD or disruptive behavior disorder (White, N=1,028; Black, N=173; Hispanic, N=244) | |||||||||
Any psychotropic medication | 93.3 | 84.0 | 75.9 | 6.8 | .100 | 14.9 | <.001 | −8.1 | .130 |
Any psychotherapy | 37.5 | 52.1 | 50.7 | −12.0 | .050 | −13.3 | .010 | 1.3 | .870 |
Both | 33.2 | 41.9 | 36.6 | −7.6 | .130 | −5.0 | .320 | −2.6 | .690 |
Mental health–related condition (White, N=3,378; Black, N=519; Hispanic, N=651) | |||||||||
Any psychotropic medication | 75.6 | 64.4 | 62.5 | 9.2 | .004 | 9.7 | .001 | −.5 | .910 |
Any psychotherapy | 43.6 | 52.0 | 50.6 | −2.2 | .420 | −.1 | .970 | −2.1 | .530 |
Both | 25.7 | 23.0 | 25.7 | 6.2 | .010 | 3.5 | .200 | 2.7 | .430 |
Other mental disorder (White, N=548; Black, N=122; Hispanic, N=128) | |||||||||
Any psychotropic medication | 81.7 | 80.2 | 73.8 | 2.4 | .660 | 9.9 | .090 | −7.5 | .310 |
Any psychotherapy | 64.0 | 68.0 | 68.8 | −7.2 | .110 | −3.0 | .620 | −4.2 | .530 |
Both | 52.5 | 52.6 | 48.8 | −1.9 | .740 | 6.7 | .290 | −8.6 | .300 |
Psychotropic Medications and Minimally Adequate Treatment
% receiving treatment | Adjusted White-Black comparisonb | Adjusted White-Hispanic comparisonb | Adjusted Black-Hispanic comparisonb | ||||||
---|---|---|---|---|---|---|---|---|---|
Mental health condition | White | Black | Hispanic | Difference (percentage points) | p | Difference (percentage points) | p | Difference (percentage points) | p |
Depressive disorder (White, N=2,762; Black, N=296; Hispanic, N=460) | |||||||||
Any antidepressant | 89.4 | 73.2 | 80.9 | 13.6 | .001 | 6.6 | .010 | −7.0 | .100 |
Any anxiolytic/sedative | 27.3 | 22.2 | 29.9 | 5.4 | .090 | −2.2 | .490 | −7.6 | .080 |
Any antipsychotic | 10.8 | 24.4 | 14.7 | −10.9 | .002 | −2.5 | .420 | 8.4 | .080 |
Minimally adequate treatmentc | 30.7 | 40.5 | 36.0 | −6.7 | .080 | −2.0 | .510 | 4.6 | .330 |
Anxiety disorder (White, N=3,177; Black, N=315; Hispanic, N=520) | |||||||||
Any antidepressant | 76.2 | 58.7 | 58.5 | 17.9 | <.001 | 16.0 | <.001 | −1.9 | .670 |
Any anxiolytic/sedative | 40.5 | 42.4 | 46.2 | −.3 | .940 | −7.2 | .030 | −6.9 | .200 |
Any antipsychotic | 10.2 | 19.2 | 13.7 | −6.4 | .020 | −2.5 | .360 | 4.0 | .300 |
Minimally adequate treatmentc | 30.7 | 36.7 | 33.3 | −3.9 | .280 | 2.5 | .380 | 6.5 | .130 |
ADHD or disruptive behavior disorder (White, N=1,028; Black, N=173; Hispanic, N=244) | |||||||||
Any stimulantd | 86.2 | 80.1 | 71.9 | 3.9 | .410 | 13.9 | .001 | 10.1 | .090 |
Any anxiolytic/sedative | 10.6 | 10.8 | 6.7e | −2.6 | .380 | .2 | .950 | 2.8 | .460 |
Any antipsychotic | 10.7 | 15.2 | 10.5e | −2.5 | .560 | −.8 | .810 | 1.8 | .710 |
Minimally adequate treatmentc | 36.9 | 42.3 | 35.3 | −1.0 | .850 | 4.0 | .300 | 5.0 | .420 |
Discussion
Conclusions
Supplementary Material
- Download
- 35.13 KB
References
Information & Authors
Information
Published In
History
Keywords
Authors
Competing Interests
Funding Information
Metrics & Citations
Metrics
Citations
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
There are no citations for this item
View Options
View options
PDF/ePub
View PDF/ePubGet Access
Login options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).