UCLA

Inequalities in mental health care (MHC) access and quality are prominent and disproportionately affect racial/ethnic minority group members than non-Latino Whites in the United States. Understanding the mechanisms that lead to these inequalities is critical to informing MHC policies and improving practice guidelines for treating mental conditions in these populations. An unexplored area in mental health disparities research is examining how perceptions of need for MHC may generate a ripple effect of disparities throughout specific stages of the mental illness careers of racial/ethnic minority populations with a probable mental disorder.

This dissertation consists of three studies examining: (1) how racial/ethnic minorities and non-Latino Whites come to develop a perceived need for MHC; (2) how racial/ethnic differences in perceived need may lead to disparities in mental health services utilization; and (3) how racial/ethnic disparities in role impairment are affected by perceived need. Data are from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys, which are comprised of large, probability samples of the major racial/ethnic minority groups in the United States, including Asians, Latinos, African Americans, Afro-Caribbeans, and non-Latino Whites. Different methodological approaches were employed in each study, including logistic and probit regression models and selection models (i.e., Heckman sample selection and bivariate probit regression techniques) to treat endongeneity due to sample selection and reverse causality bias.

Results suggest that racial/ethnic differences in perceived need may affect disparities in MHC. First, racial/ethnic minorities with a probable mental disorder, in particular African Americans, were less likely than non-Latino Whites to recognize and perceive a need for care. Differences in the factors associated with perceived need also varied across groups (e.g., variables associated with immigrant status significantly predicted perceived need among Asians and Latinos whereas education was more palpable for African Americans). Second, although a strong predictor of mental health service utilization overall, differences in perceived need helped explain why certain racial/ethnic groups, particularly Asians and African Americans, underutilized mental health services than non-Latino Whites. Lastly, African Americans and Afro-Caribbeans were more prone to experience frequent impairment, as indexed by having eight or more days with role limitations in the past month, than non-Latino Whites. These disparities in role limitations, however, were not affected by differences in perceived need and previous experiences with the MHC system.

The findings from this dissertation research demonstrate that racial/ethnic disparities in mental health and MHC are not unique to one part of the mental illness career; rather, disparities may accumulate over the course of the illness career, manifesting as cumulative disadvantage. The observed disparities might be due to limitations in mental health literacy and structural factors that affect access and quality of MHC among racial/ethnic minorities. Current efforts of the Patient Protection and Affordable Care Act aimed at expanding health coverage and improving quality and the availability of culturally relevant mental health services may help ameliorate some of these disparities. Nevertheless, efforts to understand how disparities move across subsequent stages of the mental illness career should continue in order to better inform policies designed to improve MHC participation, quality, and outcomes among racial/ethnic minorities.