Disparities in mental health service use of racial and ethnic minority elderly adults
Open accessAbstract
Objectives: To apply the I nstitute of M edicine definition of healthcare disparities, to measure disparities in different aspects of episodes of mental health care and to identify disparities in types of mental health services used. Design: Four 2‐year longitudinal datasets from Panels 9 to 13 (2004–2009) of the Medical Expenditure Panel Surveys were combined. Setting: Large‐scale surveys of families and individuals and their medical providers across the United States. Participants: One thousand six hundred fifty‐eight participants (981 white, 303 black, and 374 Latino) aged 60 and older with probable mental healthcare needs. Measurements: Mental healthcare need was defined as a Kessler‐6 Scale score >12 and a Patient Health Questionnaire‐2 score >2. Five aspects of mental healthcare episodes were analyzed: treatment initiation, adequacy of care, duration of care, number of visits, and expenditures. Whether episodes of care included only prescription drug fills, only outpatient visits, or both was assessed. Results: Treatment initiation and adequacy were lower for blacks and Latinos than whites. Latinos experienced episodes of longer duration, more visits, and higher expenditures. Blacks and Latinos had significantly lower rates of episodes that consisted of only medication refills. Blacks had significantly greater rates of episodes with only outpatient care visits. Latinos had significantly higher rates of medication plus outpatient visits. Conclusion: Low mental health treatment initiation and poor adequacy suggest the need for culturally appropriate interventions to engage older blacks and Latinos in mental health care. The surprising findings in blacks (higher rates of outpatient care visits) and Latinos (higher rates of medication plus outpatient visits) highlight the complexities of the older adult population and suggest new avenues for disparities research.
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Traditional clinical or primary care approaches to disability have not reduced disparities in treatment access and quality of care.
“Traditional approaches that address disability in clinical or primary care contexts have failed to reduce disparities in treatment access (14) and quality of care (16).”
From Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial (2019) · cites this paper as [14]
The Results and Discussion report lower mental health treatment initiation among older Black and Latino adults than among White adults, supporting the treatment-access disparity. The paper does not evaluate traditional clinical or primary-care approaches to disability or show that those approaches failed to reduce disparities. In the citing sentence, the separate quality-of-care claim is attached to citation (16), not this source. (LLM, conf=0.85)
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“This finding was somewhat surprising given recent reports that mental health services use and antidepressant use in older persons is lower among blacks than whites (36-38) and that blacks are less likely to initiate or adhere to treatment for mental health conditions (30, 39).”
ResultOlder Latino Mental Health: A Complicated Picture
Jimenez, D. E., Garza, D. M., Cárdenas, V., & Marquine, M. J. (2020) · Innovation in Aging · doi:10.1093/geroni/igaa033 · Cited by 32 · see citing works
“Despite the cultural adaptations and the effectiveness of CBT and other evidence-based treatments, older Latinos, as a whole, have limited access to these treatments and, for reasons of stigma, are often reluctant to engage in help seeking (Jimenez, Bartels, Cardenas, & Alegria, 2012; Jimenez et al., 2013).”
BackgroundSelf-citationBarriers and Facilitators of Hispanic Older Adult Mental Health Service Utilization in the USA
Guzman, E. D., Woods‐Giscombé, C. L., & Beeber, L. S. (2014) · Issues in Mental Health Nursing · doi:10.3109/01612840.2014.939790 · Cited by 30 · see citing works
“Older Hispanics were less likely to initiate mental healthcare treatment and less likely to have an adequate amount of outpatient mental healthcare visits compared with older non-Hispanic Whites (Jimenez et al., 2013).”
BackgroundResultInfluentialJimenez, D. E., Reynolds, C. F., Alegria, M. M., Harvey, P. D., & Bartels, S. J. (2015) · Trials · doi:10.1186/s13063-015-1113-3 · Cited by 29 · see citing works
“Older African Americans have low rates of mental health service use [3], experience high stigma [59], and have high rates of co-morbidities [61].”
BackgroundSelf-citationWu, S., Ell, K., Jin, H., Vidyanti, I., Chou, C., Lee, P.-J., Gross-Schulman, S. G., Sklaroff, L. M., Belson, D., Nezu, A. M., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.7692 · Cited by 27 · see citing works
“Racial and ethnic minority populations also experience disparities in terms of mental health care, including appropriate mental health diagnosis, counseling, antidepressant medication prescriptions, and depression care follow-up [16-23].”
BackgroundHelp‐seeking for depression among Australian doctors
Ramzi, N. S. A. M., Deady, M., Petrie, K., Crawford, J., & Harvey, S. B. (2020) · Internal Medicine Journal · doi:10.1111/imj.15035 · Cited by 28 · see citing works
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Choi, N. G., DiNitto, D. M., & Marti, C. N. (2015) · BMC Research Notes · doi:10.1186/s13104-015-1269-7 · Cited by 26 · see citing works
“As summarized [17–22], stigma about mental illnesses, self-sufficiency beliefs, religious coping, negative attitudes toward professional mental health treatment use, and affordability issues are likely barriers to accessing treatment among racial/ethnic minority groups.”
BackgroundPorteny, T., Alegria, M. M., Cueto, P. D., Fuentes, L., Markle, S. L., NeMoyer, A., & Perez, G. K. (2020) · Implementation Science Communications · doi:10.1186/s43058-020-00034-4 · Cited by 25 · see citing works
“Even when symptoms are recognized, elders may not access services because of a lack of providers who can serve linguistic minorities, transportation difficulties, and limited knowledge of where to go [17].”
BackgroundStudying Stress in the Twenty-First-Century: An Update of Stress Concepts and Research
Wheaton, B., & Montazer, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.013 · Cited by 24 · see citing works
Shrestha, S., Ramos, K., Fletcher, T. L., Kraus-Schuman, C. A., Stanley, M. A., Ramsey, D. J., & Amspoker, A. B. (2019) · Aging & Mental Health · doi:10.1080/13607863.2018.1544217 · Cited by 23 · see citing works
Systemic barriers to care coordination for marginalized and vulnerable populations
Santos, P., Faughnan, K., Prost, C. A., & Tschampl, C. A. (2021) · Journal of Social Distress and the Homeless · doi:10.1080/10530789.2021.2021361 · Cited by 24 · see citing works
“…people of color, for instance, are more likely than White, non-Hispanic elders to experience poverty (Cubanski et al., 2018), poor physical and mental health (Administration for Community Living, 2017; Du & Xu, 2016), and lower-quality care (Cohen, 2008; Jimenez et al., 2013; Kim et al., 2012).”
BackgroundCHUI, C. H.-K., Arat, G., Chan, K. C. H., & Wong, P. W. C. (2019) · Journal of Applied Gerontology · doi:10.1177/0733464819873504 · Cited by 22 · see citing works
“Consistent with international ethnic minority studies (Jimenez et al., 2013; Patel, 2016; Zhang et al., 2016), we found that Nepalese older adults are disadvantaged in multiple ways, despite having the same rights to access LTC services as all Hong Kong citizens.”
ResultFortuna, K. L., Lohman, M. C., Batsis, J. A., DiNapoli, E. A., DiMilia, P. R., BRUCE, M. L., & Bartels, S. J. (2017) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217417738936 · Cited by 21 · see citing works
Self-citation¡HOLA, Amigos! Toward Preventing Anxiety and Depression in Older Latinos
Jimenez, D. E., Syed, S. A., Perdomo-Johnson, D., & Signorile, J. F. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.06.020 · Cited by 21 · see citing works
Self-citationCao, Q., & Lü, B. (2018) · Current Psychology · doi:10.1007/s12144-018-0019-0 · Cited by 21 · see citing works
The Dual Continua Model: The Foundation of the Sociology of Mental Health and Mental Illness
Keyes, C. L. M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.007 · Cited by 21 · see citing works
Giebel, C. M., Challis, D., Worden, A., Jolley, D. J., Bhui, K. S., Lambat, A., & Purandare, N. B. (2015) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4337 · Cited by 19 · see citing works
“Consequently, these groups may define symptoms and causes of mental illnesses differently (Lawrence et al., 2006), which can influence access to services and appropriate care (Jimenez et al., 2013).”
BackgroundDepression is Associated with Increased Risk for Metabolic Syndrome in Latinos with Type 2 Diabetes
Cárdenas, V., Mausbach, B. T., Sommerfeld, D. H., Jimenez, D. E., von Känel, R., Ho, J. S., Garcia, P., & Aarons, G. A. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.02.017 · Cited by 19 · see citing works
“For example, there is evidence that Latinos under-utilize specialty mental health services (32, 33), which may be a barrier for adequate treatment of depression.”
BackgroundSelf-citationJoo, J. H., Jimenez, D. E., Xu, J., & Park, M. (2019) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2019.03.015 · Cited by 18 · see citing works
Self-citationImproving Health-Related Quality of Life in Older African American and Non-Latino White Patients
Jimenez, D. E., Begley, A. E., Bartels, S. J., Alegria, M. M., Thomas, S. B., Quinn, S. C., & Reynolds, C. F. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.08.001 · Cited by 18 · see citing works
“Older Latino patients have high prevalence of anxiety and depression(16) and high mental health service use disparities.(22) Older Asian patients also report high stigma(39) and believe that mental illness is a result of medical illness.”
BackgroundSelf-citationChu, J., Benjenk, I., & Chen, J. (2021) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.09.020 · Cited by 17 · see citing works
Minority Adolescent Mental Health Diagnosis Differences in a National Sample
Martín, R., Banaag, A. L., Riggs, D. S., & Koehlmoos, T. P. (2021) · Military Medicine · doi:10.1093/milmed/usab326 · Cited by 17 · see citing works
Salcedo, S., McMaster, K. J., & Johnson, S. L. (2016) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-016-0236-x · Cited by 17 · see citing works
Alwhaibi, M., Madhavan, S., Bias, T. K., Kelly, K. M., Walkup, J. T., & Sambamoorthi, U. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201600190 · Cited by 17 · see citing works
Zhang, L., O’Malley, I. S., Cruz-Gonzalez, M. A., González, M. L. S., & Alegria, M. M. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211012802 · Cited by 16 · see citing works
“, 2007), and the racial disparities in service use identified in the current study and prior research (Jimenez et al., 2013), there is a need for additional sources of identification and referral, particularly for racial/ethnic minority populations.”
BackgroundInfluentialBotoseneanu, A., Elman, M., Allore, H. G., Dorr, D. A., Newsom, J. T., Nagel, C., & Quiñones, A. R. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.11.015 · Cited by 16 · see citing works
Marquine, M. J., & Jimenez, D. E. (2020) · International Psychogeriatrics · doi:10.1017/s1041610219000541 · Cited by 16 · see citing works
Self-citationSocioeconomic Stratification and Mental Disorder
Eaton, W. W., & Muntaner, C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.016 · Cited by 18 · see citing works
The Next Generation of Clinical-Psychological Science: Moving Toward Anti-Racism
Rodriguez-Seijas, C. A., McClendon, J., Wendt, D. C., Novacek, D. M., Ebalu, T. I., Hallion, L. S., Hassan, N. Y., Huson, K., Spielmans, G. I., Folk, J. B., et al. (2023) · Clinical Psychological Science · doi:10.1177/21677026231156545 · Cited by 15 · see citing works
“Black and Hispanic Americans are also significantly less likely to receive mental-health services compared with non-Hispanic White Americans (Alegría et al., 2002; Cook et al., 2007; Jimenez et al., 2013).”
BackgroundKim, G., Parton, J., Ford, K.-L., Bryant, A. N., Shim, R. S., & Parmelee, P. A. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300440 · Cited by 15 · see citing works
Byers, A. L., Lai, A. X., Nelson, C., & Yaffe, K. S. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.06.018 · Cited by 15 · see citing works
Understanding the Connection between Social Support and Mental Health
Brown, R. L., & Ciciurkaite, G. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.014 · Cited by 15 · see citing works
Stigma and the Reluctance to Address Mental Health Issues in Minority Communities
Kreps, G. L. (2017) · Journal of Family Strengths · doi:10.58464/2168-670x.1340 · Cited by 14 · see citing works
“health problems do not differ significantly across various racial and ethnic groups in the United States, research shows that many minority groups, especially African Americans and Latino Americans, seek and receive treatments for mental health problems at a much lower rate than the general population does, resulting…”
BackgroundHuang, C. Y., Zane, N. W. S., Hunter, L., Vang, L., Apesoa‐Varano, E. C., & Joseph, J. G. (2023) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000591 · Cited by 14 · see citing works
Vida Calma: CBT for Anxiety with a Spanish-Speaking Hispanic Adult
Ramos, K., Cortes, J., WILSON, N. L., Kunik, M. E., & Stanley, M. A. (2017) · Clinical Gerontologist · doi:10.1080/07317115.2017.1292978 · Cited by 14 · see citing works
Morin, C. M., & Jarrin, D. C. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.05.003 · Cited by 14 · see citing works
“In general, women, middle-aged and older individuals, and those with higher education and socioeconomic statuses are more inclined to seek healthcare services, whereas individuals from ethnic minority groups are less likely to seek treatment [9,10].”
BackgroundAccess to healthcare and depression severity in vulnerable groups the US: NHANES 2013–2018
Kemp, J., Taylor, V. H., & Kanagasabai, T. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.02.081 · Cited by 13 · see citing works
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Wyman, M. F., Jonaitis, E. M., Ward, E. C., Zuelsdorff, M. L., & Gleason, C. E. (2019) · International Psychogeriatrics · doi:10.1017/s1041610219001133 · Cited by 12 · see citing works
Jang, Y., Chiriboga, D. A., Park, N. S., Yoon, H., Cho, Y. J., Hong, S., Nam, S., Rhee, M., Bernstein, K. S., & Kim, M. T. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1758908 · Cited by 12 · see citing works
Schembri, S. T., & Ghaddar, S. F. (2017) · Journal of Consumer Affairs · doi:10.1111/joca.12146 · Cited by 12 · see citing works
Challenges to Engaging Diverse Participants in Community-Based Aging in Place Initiatives
Davitt, J. K., Greenfield, E. A., Lehning, A. J., & Scharlach, A. E. (2017) · Journal of Community Practice · doi:10.1080/10705422.2017.1354346 · Cited by 12 · see citing works
After Older Adult Maltreatment: Service Needs and Barriers
Olomi, J. M., Wright, N. M., Hasche, L. K., & DePrince, A. P. (2019) · Journal of Gerontological Social Work · doi:10.1080/01634372.2019.1668517 · Cited by 12 · see citing works
Nakash, O., Hayat, T., Abu‐Kaf, S., & Cohen, M. (2019) · Journal of Gerontological Social Work · doi:10.1080/01634372.2019.1709247 · Cited by 12 · see citing works
“Instead of basing mental health-care treatment decisions on objective weighing of risks and benefits for different treatments and outcomes, among older immigrants and ethnic minority preferences are based on limited information with influence from prior individual and collective experience (Jimenez et al., 2013).”
BackgroundCognitive Behavioral Therapy with Older Adults
Ishikawa, R. Z., & Mace, R. A. (2023) · Current clinical psychiatry · doi:10.1007/978-3-031-29368-9_26 · Cited by 12 · see citing works
Fung, V., Price, M., McDowell, A., Nierenberg, A. A., Hsu, J., Newhouse, J. P., & Cook, B. L. (2023) · Health Affairs · doi:10.1377/hlthaff.2022.00624 · Cited by 11 · see citing works
Self-citationDelaCruz, J. J., Karpiak, S., & Brennan-Ing, M. (2014) · Global Journal of Health Science · doi:10.5539/gjhs.v7n1p133 · Cited by 13 · see citing works
“Other barriers for Latinos to behavioral health care include transportation difficulties, employment issues, patient-provider issues, and immigrant documentation (Jimenez et al., 2013).”
BackgroundInfluentialLaNoue, M. D., Harvey, A., Mautner, D., Ku, B. S., & Scott, K. C. (2015) · Health Psychology Open · doi:10.1177/2055102915615045 · Cited by 11 · see citing works
“…are also documented differences in colon cancer and prostate screening (Harmon et al., 2014), mental health screening and treatment preferences (Jimenez et al., 2013), and diabetes self-care (Johnson et al., 2014) between African-Americans and Caucasians, differences which have implicated…”
BackgroundLee, S., Matejkowski, J. C., & Han, W. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9899-8 · Cited by 11 · see citing works
“For example, the literature has documented that non-Hispanic whites are more likely to use any mental health services than Blacks and Latinos (Blanco et al. 2007; Jimenez et al. 2013).”
BackgroundBallone, N., & Richards, E. M. (2023) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2023.04.011 · Cited by 9 · see citing works
Addressing Health Disparities in America: Analysis of Community Health Improvement Plans
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The role social diversity plays in enhancing mental health literacy among the elderly
Hayat, T., Nakash, O., Abu‐Kaf, S., & Cohen, M. (2020) · Online Information Review · doi:10.1108/oir-03-2020-0110 · Cited by 10 · see citing works
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Jimenez, D. E., Cook, B. L., Kim, G., Reynolds, C. F., Alegria, M. M., Coe-Odess, S., & Bartels, S. J. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400246 · Cited by 9 · see citing works
“Prior research has highlighted racial-ethnic disparities in mental health expenditures (6,14).”
BackgroundSelf-citationPark, H.-J., Choi, E., Park, Y., & Wenzel, J. A. (2017) · Issues in Mental Health Nursing · doi:10.1080/01612840.2017.1379575 · Cited by 9 · see citing works
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Well-Being across the Life Course
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“…and contextual factors shape mental health experi ences (e.g. perceived causes, treatment options and prefer ences, coping; Ferraro et al., 2009; Lazarus and Folkman, 1984: 142; Kleinman, 2020) that contribute to the underutili zation of mental services in older Latinx (Jimenez et al., 2013).”
BackgroundHelp Seeking Behavior in a Diverse Sample of Asian American Adults
Nguyen, P., Corona, R., DeCarlo, M. P., Yaros, A., Le, A.-T. H., & Compton, K. S. (2018) · Journal of Ethnic and Cultural Studies · doi:10.29333/ejecs/124 · Cited by 7 · see citing works
“The Problem Will Pass:” Attitudes of Latinx Adults Toward Mental Illness and Help Seeking
Crowe, A., Averett, P. E., Harris, J. R. A., Crumb, L., & Dietz, S. S. (2022) · International Journal for the Advancement of Counselling · doi:10.1007/s10447-021-09425-1 · Cited by 7 · see citing works
- Authors
- Jimenez, D. E., Cook, B., Bartels, S. J., & Alegría, M.
- Affiliations
- Dartmouth College (US)
- Cambridge Health Alliance (US)
- Center for Multicultural Mental Health Research Cambridge Health Alliance Somerville Massachusetts USA
- Corresponding author
- Jimenez, Daniel E.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2012-12-18
- Volume
- 61
- Issue
- 1
- Pages
- 18-25
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3545089
- OpenAlex
- W2073417746
- Cited by
- 201
- References
- 53
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 11 · 2023: 12 · 2022: 10 · 2021: 11 · 2020: 16 · 2019: 21 · 2018: 13 · 2017: 57 · 2016: 8 · 2015: 10 · 2014: 11 · 2013: 4 · 2012: 2
- FWCI
- 12.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Centers for Disease Control and Prevention
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- mental health care disparities, racial and ethnic minorities, older adults, Black older adults, Latino older adults, treatment initiation, duration of care, mental health care costs, outpatient visits, psychotropic drugs, culturally sensitive interventions, mental health service utilization
- MeSH terms
- Aged, Aged, 80 and over, Ethnicity, Female, Follow-Up Studies, Health Services Accessibility, Humans, Male, Mental Health Services, Middle Aged, Minority Groups, Retrospective Studies, Socioeconomic Factors, United States, Health Care Surveys, Racial Groups, Healthcare Disparities
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