Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study

Abstract

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

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Funding

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health under Award Number R01MD009719. Dr Jackson is supported by the NIMHD Center for Integrative Approaches to Health Disparities (P60-MD002249). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Jennifer Greif Green.

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In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The other authors declare no competing interests.

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Appendix

Appendix

Barriers to use and reasons for dropout treatment: CPES surveys.

Barriers to use Reasons for dropout
Low perceived need Low perceived need
The problem went away by itself, and I did not really need help You didn’t need help anymore
Structural barriers Structural barriers
My health insurance would not cover this type of treatment The therapist or counselor left or moved away
I was concerned about how much money it would cost The policies were a hassle
I was unsure about where to go or who to see There were problems with lack of time, schedule change, or lack of transportation
I thought it would take too much time or be inconvenient You moved
I could not get an appointment Treatment was too expensive
I had problems with things like transportation, childcare, or scheduling that would have made it hard to get treatment Your health insurance would not pay for more treatment
Attitudinal barriers Attitudinal barriers
I thought the problem would get better by itself You got better
I didn’t think treatment would work You were not getting better
I was concerned about what others might think if they found out I was in treatment You wanted to handle the problem on your own
I wanted to handle the problem on my own You had bad experiences with the treatment providers
I was scared about being put in the hospital against my will You were concerned about what people would think if they found out you were in treatment
I was not satisfied with available services You were treated badly or unfairly
I received treatment before and it did not work You felt out of place
The problem didn’t bother me very much Your family wanted you to stop

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Green, J.G., McLaughlin, K.A., Fillbrunn, M. et al. Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study. Adm Policy Ment Health 47, 606–616 (2020). https://doi.org/10.1007/s10488-020-01021-6

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Keywords

  • CPES
  • Mental health
  • Services
  • Treatment
  • Disparities
  • Inequities
  • Race/ethnicity