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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 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]
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Self-citationAssessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care
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Self-citationBarriers to and facilitators of diabetes self‐management with elderly Korean‐American immigrants
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“Specifically, the faith and the explanatory model on the cause of MH illness vary across cultures (Jimenez et al., 2013).”
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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
“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).”
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“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).”
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“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].”
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Self-citation¡HOLA, Amigos! Toward Preventing Anxiety and Depression in Older Latinos
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“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
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“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.”
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“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.”
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“, 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.”
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“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).”
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“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
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“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
“…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
“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
Addressing Health Disparities in America: Analysis of Community Health Improvement Plans
Inderstrodt, J. M., Perrault, E. K., Hintz, E. A., & Hildenbrand, G. M. (2019) · Nursing Research · doi:10.1097/nnr.0000000000000364 · Cited by 10
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
Medeiros, S. F., Coelho, R., Millett, C. J., Saraceni, V., Coeli, C. M., Trajman, A., Rasella, D., Durovni, B., & Hone, T. (2023) · BMJ Global Health · doi:10.1136/bmjgh-2023-013327 · Cited by 9
Eliacin, J., Cunningham, B. A., Partin, M. R., Gravely, A. A., Taylor, B. C., Gordon, H. S., Saha, S. S., & Burgess, D. J. (2019) · Health Equity · doi:10.1089/heq.2019.0018 · Cited by 9
Link, B. G., & Phelan, J. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.024 · Cited by 11
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
“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
Kaltman, S. I., Watson, M. R., Campoli, M., Serrano, A., Talisman, N. W., Kirkpatrick, L. A., Méte, M., & Green, B. L. (2019) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000251 · Cited by 9
Rosenfield, S., Kato, K., & Smith, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.017 · Cited by 9
Washburn, M., Hagedorn, A., & Moore, S. (2021) · Journal of Technology in Human Services · doi:10.1080/15228835.2021.1915927 · Cited by 8
Horwitz, A. V. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.004 · Cited by 8
Keith, V. M., & Brown, D. R. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.019 · Cited by 9
Browne, J., & Mohamed, S. (2022) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2022.02.009 · Cited by 8
Bucy, T., Moeller, K., Skarphol, T., Shippee, N., Bowblis, J. R., Winkelman, T., & Shippee, T. (2022) · Journal of Aging & Social Policy · doi:10.1080/08959420.2022.2083882 · Cited by 8
Joo, J. H., Davey-Rothwell, M. A., Choi, N. G., Gallo, J. J., Mace, R. A., & Xie, A. (2023) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2023.01.023 · Cited by 9
Well-Being across the Life Course
Mirowsky, J., & Ross, C. E. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.021 · Cited by 8
Alkholy, R., Lovell, K., Bee, P., & Pedley, R. (2022) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2022.100440 · Cited by 8
Camacho, D., Bhattacharya, A., Moore, K. L., Aranda, M., & Lukens, E. P. (2023) · Methodological Innovations · doi:10.1177/20597991231202866 · Cited by 7
“…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
“The Problem Will Pass:” Attitudes of Latinx Adults Toward Mental Illness and Help Seeking
Crowe, A., Averett, P. E., Harris, J., Crumb, L., & Dietz, S. S. (2022) · International Journal for the Advancement of Counselling · doi:10.1007/s10447-021-09425-1 · Cited by 6
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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