Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Sample
Measures
Screening measure: mental health service use.
Outcome variables: satisfaction with and perceived benefits from mental health services.
Geographic region.
Covariates.
Analyses
Results
Sample
U.S. (N=2,160) | Northeast (N=372) | South (N=794) | Midwest (N=389) | West (N=574) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Characteristic | N | % | N | % | N | % | N | % | N | % |
Race-ethnicity | ||||||||||
Black | 528 | 24 | 118 | 32 | 266 | 34 | 67 | 17 | 72 | 13 |
White | 1,076 | 50 | 163 | 44 | 342 | 43 | 174 | 45 | 378 | 66 |
Hispanic/Latino | 412 | 19 | 64 | 17 | 141 | 18 | 104 | 27 | 97 | 17 |
Asian | 144 | 7 | 27 | 7 | 45 | 6 | 44 | 11 | 27 | 5 |
Age | ||||||||||
<40 | 999 | 46 | 163 | 44 | 362 | 46 | 186 | 48 | 270 | 47 |
40–59 | 904 | 42 | 165 | 44 | 345 | 44 | 151 | 39 | 233 | 41 |
≥60 | 257 | 12 | 44 | 12 | 87 | 11 | 52 | 13 | 71 | 12 |
Sex | ||||||||||
Male | 676 | 31 | 112 | 30 | 251 | 32 | 128 | 33 | 179 | 31 |
Female | 1,484 | 69 | 260 | 70 | 543 | 68 | 261 | 67 | 395 | 69 |
Educational attainment (years) | ||||||||||
0–11 | 412 | 19 | 81 | 22 | 139 | 18 | 89 | 23 | 100 | 17 |
12 | 581 | 27 | 98 | 26 | 217 | 27 | 112 | 29 | 146 | 25 |
13–15 | 626 | 29 | 96 | 26 | 248 | 31 | 96 | 25 | 173 | 30 |
≥16 | 541 | 25 | 97 | 26 | 190 | 24 | 91 | 23 | 155 | 27 |
Income | ||||||||||
<$20,000 | 643 | 32 | 131 | 38 | 262 | 36 | 104 | 29 | 136 | 27 |
$20,000–$34,999 | 314 | 16 | 51 | 15 | 115 | 16 | 68 | 19 | 77 | 15 |
$35,000–$74,999 | 589 | 30 | 98 | 28 | 209 | 29 | 104 | 29 | 168 | 33 |
≥$75,000 | 441 | 22 | 66 | 19 | 148 | 20 | 89 | 24 | 132 | 26 |
Marital status | ||||||||||
Married or cohabiting | 988 | 46 | 159 | 43 | 341 | 43 | 193 | 50 | 284 | 49 |
Divorced, separated, or widowed | 610 | 28 | 111 | 30 | 225 | 28 | 105 | 27 | 158 | 28 |
Never married | 562 | 26 | 102 | 27 | 228 | 29 | 91 | 23 | 132 | 23 |
DSM-IV disorder | ||||||||||
Yes | 1,094 | 51 | 198 | 53 | 399 | 51 | 208 | 53 | 272 | 47 |
No | 1,066 | 50 | 174 | 47 | 395 | 50 | 181 | 47 | 302 | 53 |
Specialty mental health sector | ||||||||||
Yes | 1,189 | 55 | 201 | 54 | 446 | 56 | 227 | 58 | 294 | 51 |
No | 971 | 45 | 171 | 46 | 348 | 44 | 162 | 42 | 280 | 49 |
General medical sector | ||||||||||
Yes | 1,020 | 47 | 179 | 48 | 357 | 45 | 179 | 46 | 291 | 51 |
No | 1,140 | 53 | 193 | 52 | 437 | 55 | 210 | 54 | 283 | 49 |
Other service sector | ||||||||||
Yes | 1,268 | 59 | 220 | 59 | 477 | 60 | 227 | 58 | 329 | 57 |
No | 892 | 41 | 152 | 40 | 317 | 40 | 162 | 42 | 245 | 43 |
Outcome variable | ||||||||||
Satisfaction with mental health system (M±SD)b | 4.00±1.10 | 3.96±1.14 | 4.03±1.10 | 3.96±1.13 | 4.02±1.06 | |||||
Perceived benefit from mental health system (M±SD)c | 3.15±1.01 | 3.11±1.03 | 3.18±.98 | 3.12±1.03 | 3.17±1.02 |
GLM analyses
Satisfaction with mental health services.
U.S. | Northeast | South | Midwest | West | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Characteristic | LSM | 95% CL | p | LSM | 95% CL | p | LSM | 95% CL | p | LSM | 95% CL | p | LSM | 95% CL | p |
Region | .966 | — | — | — | — | ||||||||||
Northeast | 4.03 | 3.78–4.28 | — | — | — | — | — | — | — | — | |||||
South | 4.06 | 3.89–4.22 | — | — | — | — | — | — | — | — | |||||
Midwest | 4.00 | 3.79–4.21 | — | — | — | — | — | — | — | — | |||||
West | 4.08 | 3.83–4.32 | — | — | — | — | — | — | — | — | |||||
Race-ethnicity | .065 | .522 | .548 | .176 | ≤.001 | ||||||||||
Black | 4.17 | 3.96–4.37 | 4.01 | 3.74–4.27 | 4.13 | 3.97–4.30 | 4.01 | 3.70–4.31 | 4.34 | 4.09–4.60 | |||||
White | 4.12 | 4.05–4.19 | 4.11 | 3.89–4.34 | 4.03 | 3.88–4.17 | 4.23 | 4.02–4.44 | 4.10 | 3.96–4.23 | |||||
Hispanic/Latino | 3.91 | 3.74–4.07 | 3.88 | 3.55–4.20 | 3.99 | 3.79–4.19 | 3.91 | 3.66–4.16 | 3.63 | 3.40–3.86 | |||||
Asian | 3.97 | 3.62–4.32 | 3.86 | 3.41–4.31 | 3.97 | 3.64–4.31 | 4.08 | 3.73–4.43 | 3.82 | 3.42–4.22 | |||||
Covariate | |||||||||||||||
Age | .005 | .603 | .367 | .045 | .009 | ||||||||||
<40 | 3.91 | 3.79–4.04 | 3.95 | 3.72–4.17 | 3.94 | 3.78–4.09 | 3.84 | 3.64–4.03 | 3.78 | 3.60–3.95 | |||||
40–59 | 4.07 | 3.94–4.20 | 3.87 | 3.65–4.09 | 4.03 | 3.88–4.18 | 4.00 | 3.78–4.22 | 4.07 | 3.90–4.24 | |||||
≥60 | 4.14 | 3.96–4.32 | 4.08 | 3.66–4.49 | 4.12 | 3.86–4.39 | 4.33 | 3.99–4.67 | 4.08 | 3.79–4.36 | |||||
Sex | .406 | .142 | .281 | .308 | .057 | ||||||||||
Male | 4.02 | 3.89–4.15 | 3.87 | 3.60–4.13 | 4.08 | 3.91–4.25 | 4.12 | 3.89–4.35 | 3.88 | 3.68–4.08 | |||||
Female | 4.06 | 3.94–4.18 | 4.06 | 3.86–4.27 | 3.98 | 3.89–4.12 | 3.99 | 3.80–4.17 | 4.07 | 3.91–4.22 | |||||
Educational attainment (years) | .001 | .440 | .495 | .544 | .193 | ||||||||||
0–11 | 4.06 | 3.90–4.21 | 4.08 | 3.77–4.40 | 4.14 | 3.92–4.36 | 4.04 | 3.77–4.31 | 4.09 | 3.86–4.33 | |||||
12 | 4.00 | 3.86–4.15 | 3.96 | 3.67–4.25 | 4.06 | 3.87–4.25 | 4.09 | 3.83–4.34 | 3.96 | 3.75–4.17 | |||||
13–15 | 3.92 | 3.78–4.07 | 4.03 | 3.74–4.32 | 3.97 | 3.80–4.15 | 3.92 | 3.65–4.19 | 3.82 | 3.62–4.03 | |||||
≥16 | 4.18 | 4.03–4.32 | 3.78 | 3.49–4.07 | 3.95 | 3.76–4.14 | 4.17 | 3.89–4.46 | 4.02 | 3.79–4.24 | |||||
Income | .001 | .130 | .044 | .777 | .001 | ||||||||||
<$20,000 | 3.87 | 3.73–4.01 | 3.76 | 3.51–4.01 | 3.98 | 3.73–4.18 | 4.02 | 3.77–4.27 | 3.73 | 3.52–3.95 | |||||
$20,000–$34,999 | 4.22 | 4.06–4.38 | 4.06 | 3.72–4.41 | 3.96 | 3.74–4.19 | 4.06 | 3.76–4.35 | 4.29 | 4.03–4.54 | |||||
$35,000–$74,999 | 4.02 | 3.88–4.16 | 3.84 | 3.57–4.11 | 4.23 | 4.04–4.41 | 3.98 | 3.73–4.24 | 3.87 | 3.67–4.07 | |||||
≥$75,000 | 4.05 | 3.90–4.20 | 4.19 | 3.84–4.54 | 3.96 | 3.73–4.18 | 4.16 | 3.87–4.45 | 4.00 | 3.78–4.23 | |||||
Marital status | .479 | .529 | .232 | .767 | .001 | ||||||||||
Married or cohabiting | 4.08 | 3.96–4.21 | 3.88 | 3.64–4.12 | 4.13 | 3.98–4.28 | 4.07 | 3.87–4.27 | 4.15 | 3.97–4.33 | |||||
Divorced, separated, or widowed | 4.01 | 3.87–4.15 | 4.07 | 3.80–4.33 | 4.01 | 3.82–4.20 | 3.99 | 3.73–4.24 | 3.72 | 3.51–3.92 | |||||
Never married | 4.03 | 3.88–4.18 | 3.95 | 3.64–4.25 | 3.95 | 3.76–4.15 | 4.11 | 3.82–4.41 | 4.06 | 3.83–4.29 | |||||
DSM-IV disorder | ≤.001 | .085 | .397 | .956 | .004 | ||||||||||
Yes | 3.92 | 3.79–4.04 | 3.85 | 3.61–4.10 | 4.00 | 3.84–4.15 | 4.05 | 3.85–4.26 | 3.84 | 3.67–4.02 | |||||
No | 4.17 | 4.04–4.29 | 4.08 | 3.86–4.29 | 4.07 | 3.92–4.21 | 4.06 | 3.85–4.27 | 4.10 | 3.93–4.28 | |||||
Service sector | |||||||||||||||
Specialty mental health | ≤.001 | .007 | ≤.001 | .007 | ≤.001 | ||||||||||
Yes | 3.81 | 3.68–3.94 | 3.79 | 3.57–4.01 | 3.79 | 3.64–3.93 | 3.87 | 3.67–4.08 | 3.78 | 3.60–3.96 | |||||
No | 4.27 | 4.14–4.40 | 4.14 | 3.90–4.38 | 4.28 | 4.12–4.44 | 4.24 | 4.02–4.46 | 4.17 | 3.99–4.34 | |||||
General medical | ≤.001 | .002 | ≤.001 | ≤.001 | ≤.001 | ||||||||||
Yes | 3.82 | 3.70–3.95 | 3.75 | 3.52–3.98 | 3.81 | 3.65–3.96 | 3.82 | 3.61–4.02 | 3.74 | 3.55–3.92 | |||||
No | 4.26 | 4.13–4.39 | 4.18 | 3.94–4.42 | 4.26 | 4.10–4.41 | 4.29 | 4.08–4.51 | 4.21 | 4.03–4.39 | |||||
Other | .990 | .046 | .474 | .946 | .643 | ||||||||||
Yes | 4.04 | 3.92–4.17 | 4.09 | 3.88–4.31 | 4.06 | 3.91–4.21 | 4.05 | 3.86–4.25 | 4.00 | 3.82–4.17 | |||||
No | 4.04 | 3.91–4.17 | 3.84 | 3.60–4.08 | 4.00 | 3.84–4.16 | 4.60 | 2.84–4.28 | 3.95 | 3.78–4.13 |
Perceived benefits from mental health services.
U.S. | Northeast | South | Midwest | West | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Characteristic | LSM | 95% CL | p | LSM | 95% CL | p | LSM | 95% CL | p | LSM | 95% CL | p | LSM | 95% CL | p |
Region | .698 | — | — | — | — | ||||||||||
Northeast | 3.15 | 2.92–3.39 | — | — | — | — | — | — | — | — | |||||
South | 3.28 | 3.13–3.44 | — | — | — | — | — | — | — | — | |||||
Midwest | 3.16 | 2.97–3.36 | — | — | — | — | — | — | — | — | |||||
West | 3.26 | 3.04–3.49 | — | — | — | — | — | — | — | — | |||||
Race-ethnicity | .853 | .644 | .335 | .969 | .001 | ||||||||||
Black | 3.26 | 3.07–3.45 | 3.14 | 2.90–3.37 | 3.18 | 3.04–3.33 | 3.20 | 2.93–3.47 | 3.51 | 3.26–3.77 | |||||
White | 3.24 | 3.17–3.30 | 3.24 | 3.04–3.43 | 3.21 | 3.08–3.34 | 3.24 | 3.06–3.43 | 3.25 | 3.11–3.38 | |||||
Hispanic/Latino | 3.18 | 3.02–3.33 | 3.15 | 2.86–3.44 | 3.36 | 3.18–3.54 | 3.26 | 3.03–3.49 | 2.87 | 2.65–3.10 | |||||
Asian | 3.17 | 2.86–3.51 | 2.98 | 2.58–3.37 | 3.29 | 3.00–3.59 | 3.18 | 2.86–3.50 | 3.18 | 2.79–3.57 | |||||
Covariate | |||||||||||||||
Age | ≤.001 | .466 | .247 | .037 | .019 | ||||||||||
<40 | 3.07 | 2.96–3.18 | 3.04 | 2.84–3.24 | 3.16 | 3.03–3.30 | 3.00 | 2.83–3.18 | 3.01 | 2.84–3.17 | |||||
40–59 | 3.24 | 3.12–3.36 | 3.05 | 2.86–3.25 | 3.28 | 3.14–3.41 | 3.23 | 3.03–3.43 | 3.23 | 3.06–3.40 | |||||
≥60 | 3.33 | 3.17–3.50 | 3.28 | 2.92–3.65 | 3.34 | 3.11–3.57 | 3.43 | 3.12–3.74 | 3.38 | 3.10–3.66 | |||||
Sex | .034 | .005 | .084 | .369 | .015 | ||||||||||
Male | 3.16 | 3.04–3.29 | 2.96 | 2.73–3.19 | 3.33 | 3.18–3.48 | 3.17 | 2.96–3.38 | 3.09 | 2.90–3.28 | |||||
Female | 3.26 | 3.15–3.38 | 3.29 | 3.11–3.47 | 3.19 | 3.07–3.31 | 3.27 | 3.11–3.44 | 3.32 | 3.17–3.47 | |||||
Educational attainment (years) | ≤.001 | .480 | .518 | .771 | .164 | ||||||||||
0–11 | 3.28 | 3.14–3.43 | 3.29 | 3.02–3.57 | 3.34 | 3.15–3.54 | 3.22 | 2.97–3.46 | 3.39 | 3.16–3.62 | |||||
12 | 3.07 | 2.94–3.20 | 3.11 | 2.85–3.37 | 3.23 | 3.06–3.39 | 3.14 | 2.91–3.36 | 3.10 | 2.89–3.31 | |||||
13–15 | 3.15 | 3.02–3.28 | 3.09 | 2.83–3.34 | 3.19 | 3.04–3.35 | 3.23 | 2.99–3.47 | 3.12 | 2.92–3.32 | |||||
≥16 | 3.35 | 3.22–3.49 | 3.01 | 2.76–3.27 | 3.28 | 3.11–3.45 | 3.30 | 3.04–3.56 | 3.20 | 2.98–3.42 | |||||
Income | .002 | .061 | .033 | .471 | .030 | ||||||||||
<$20,000 | 3.07 | 2.94–3.20 | 2.89 | 2.67–3.12 | 3.21 | 3.06–3.35 | 3.13 | 2.90–3.35 | 2.96 | 2.76–3.17 | |||||
$20,000–$34,999 | 3.35 | 3.20–3.50 | 3.16 | 2.85–3.46 | 3.34 | 3.14–3.54 | 3.31 | 3.05–3.58 | 3.35 | 3.10–3.60 | |||||
$35,000–$74,999 | 3.23 | 3.11–3.36 | 3.08 | 2.84–3.32 | 3.39 | 3.22–3.55 | 3.14 | 2.90–3.37 | 3.22 | 3.02–3.41 | |||||
≥$75,000 | 3.20 | 3.06–3.34 | 3.38 | 3.07–3.69 | 3.11 | 2.91–3.31 | 3.31 | 3.05–3.57 | 3.29 | 3.07–3.51 | |||||
Marital status | .112 | .768 | .218 | .665 | .118 | ||||||||||
Married or cohabiting | 3.18 | 3.06–3.29 | 3.08 | 2.86–3.29 | 3.28 | 3.15–3.42 | 3.15 | 2.97–3.33 | 3.27 | 3.10–3.45 | |||||
Divorced, separated, or widowed | 3.29 | 3.16–3.41 | 3.12 | 2.89–3.35 | 3.34 | 3.17–3.50 | 3.27 | 3.04–3.50 | 3.06 | 2.86–3.26 | |||||
Never married | 3.18 | 3.04–3.32 | 3.18 | 2.91–3.45 | 3.15 | 2.99–3.34 | 3.24 | 2.97–3.50 | 3.28 | 3.05–3.50 | |||||
DSM-IV disorder | ≤.001 | .118 | .109 | .680 | .008 | ||||||||||
Yes | 3.12 | 3.00–3.24 | 3.04 | 2.82–3.25 | 3.20 | 3.06–3.34 | 3.20 | 3.01–3.38 | 3.09 | 2.91–3.26 | |||||
No | 3.31 | 3.19–3.42 | 3.21 | 3.02–3.41 | 3.32 | 3.19–3.45 | 3.24 | 3.06–3.43 | 3.32 | 3.15–3.49 | |||||
Service sector | |||||||||||||||
Specialty mental health | ≤.001 | ≤.001 | ≤.001 | ≤.001 | ≤.001 | ||||||||||
Yes | 2.97 | 2.85–3.08 | 2.91 | 2.71–3.11 | 3.00 | 2.87–3.13 | 2.99 | 2.81–3.17 | 3.03 | 2.85–3.21 | |||||
No | 3.46 | 3.34–3.58 | 3.34 | 3.13–3.55 | 3.52 | 3.38–3.66 | 3.45 | 3.26–3.65 | 3.38 | 3.21–3.55 | |||||
General medical | ≤.001 | ≤.001 | ≤.001 | ≤.001 | ≤.001 | ||||||||||
Yes | 2.97 | 2.85–3.09 | 2.83 | 2.63–3.04 | 3.04 | 2.90–3.18 | 2.97 | 2.79–3.16 | 2.95 | 2.77–3.12 | |||||
No | 3.46 | 3.34–3.58 | 3.42 | 3.21–3.63 | 3.48 | 3.35–3.62 | 3.47 | 3.28–3.66 | 3.46 | 3.29–3.63 | |||||
Other | .542 | .671 | .146 | .662 | .387 | ||||||||||
Yes | 3.20 | 3.09–3.32 | 3.15 | 2.96–3.34 | 3.32 | 3.18–3.45 | 3.20 | 3.02–3.37 | 3.24 | 3.07–3.41 | |||||
No | 3.23 | 3.11–3.35 | 3.10 | 2.89–3.31 | 3.21 | 3.07–3.34 | 3.25 | 3.05–3.44 | 3.16 | 2.99–3.34 |
Discussion
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Cover: Two Children Watching the Clouds in a Field, by Elizabeth Shippen Green. © Copyright 2014 National Museum of American Illustration™, Newport, RI. Photos courtesy Archives of the American Illustrators Gallery™, New York City.
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