Race differences in mental health services for depression and anxiety: Treatment rates, settings, and quality among whites, blacks, and Latinos in the Collaborative Psychiatric Epidemiology Surveys

BACKGROUND: As the racial composition of the U.S. population grows ever more diverse, landmark healthcare legislation holds the promise of reducing long-standing race disparities in health.;OBJECTIVES: This study examines Latino- and black-white differences in 12-month rates of mental health (MH) service use, the specific settings in which services are received, and the adequacy of the services rendered. It focuses specifically on care for depression and anxiety disorders, the two most common forms of mental illness in the U.S.;DATA: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES) project, which combined three representative surveys of mental health and MH service use among American adults. Focused on the influence of race and ethnicity, CPES component surveys oversampled nonwhite respondents. Core diagnostic assessment was completed using the Composite International Diagnostic Interview (CIDI).;METHODS: MH service use included use of any of five sectors: psychiatry (PSY), other mental health specialty (OMH), general medical (GM), human services (HS), and complementary-alternative medicine (CAM). Multi-sector service profiles included PSY, OMH with GM, OMH-only, GM-only, HS-only, and CAM-only. Adequate care was defined as psychotherapy (i.e., eight or more visits to psychiatrist or other MH specialist lasting at least 30 minutes) and/or pharmacotherapy (i.e., four or more visits to psychiatrist or other physician plus use of suitable prescription medication for at least 60 days).;RESULTS: Latinos and blacks were less likely than whites to receive any services. Compared to whites, black service users were less likely to use the GM-only profile and more likely to use the HS-only profile. Among service users with depression and anxiety disorders, blacks were less likely than whites to receive adequate psycho- or pharmacotherapeutic services. Among those reporting use of prescription medications, both blacks and Latinos were more likely than whites to have taken medications other than those recommended for their particular disorders.;CONCLUSIONS: Each year, many depressed and anxious Americans go undertreated or untreated altogether, and these shortfalls are more pronounced among Latinos and especially blacks than among whites. Future research should investigate the influence of race differences in self-perceived need and beliefs and attitudes about mental health and mental healthcare.