Purpose: Latino adults in need of mental health care are less likely than non-Latino Whites to access mental health services, and when they do receive care its more likely to be poor in quality (USDHHS, 2001). As a result of these disparities in care, Latinos experience a disproportionate burden of disability associated with mental disorders. The purpose of this study is to systematically review epidemiological studies published from 1980 to the present that have examined Latinos' access to mental health care in order to inform social work practice and future research to this underserved population.

Methods: Electronic bibliographic databases (i.e., PsycINFO, Social Science Abstracts and Medline) as well as manual searches were used to identify relevant articles. In addition, articles were chosen for review if they had used random-community samples, standardized diagnostic instruments (e.g., Diagnostic Interview Schedule, Composite International Diagnostic Instrument), included samples of Latino adults, 18 years of age or older, and reported access findings, such as rates, frequency, and types of services used, for a mental health problem. Two reviewers working independently abstracted and analyzed studies' theoretical perspectives, designs, methods, and findings. Reviewers then met to discuss and come to a consensus of their analyses.

Findings: Fourteen articles presenting findings from epidemiological studies, such as the Epidemiological Catchment Area Study, the National Comorbidity Study, and the Mexican American Prevalence and Service Survey among others were included in this review. The majority of studies used cross-sectional designs and multivariate models (e.g., logistic regression) to identify correlates of service use. The main Latino groups represented across these studies were Mexicans and Puerto Ricans, and to a lesser extent Cubans. The Behavioral Model of Health Service Use and the Network-Episode Model were the most commonly used theoretical perspectives. Studies consistently found that Latinos compared to Non-Latino Whites with similar mental health needs (e.g., psychiatric diagnosis, level of functional impairment) underutilized specialty mental health services. Moreover, Latinos, particularly immigrants, in need of mental health care turned more often to the primary health care sector for treatment than to the specialty mental health sector. It was also reported that Latinos relied on a combination of professional and lay advisors (e.g., family members, clergy, traditional healers) to cope with mental disorders. A complex interplay of structural, economic, psychiatric and cultural factors was found to influence Latinos' access to mental health services.

Implications: Practices and policies must be informed by sound research that not only documents these disparities in mental health care but also produces evidence that can help explain how these disparities occur. Building upon the findings from this review, future directions for research and the development of interventions and policies aimed at improving Latinos' access to mental health care are discussed.

References United States Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity: A supplement to mental health: A report of the Surgeon General. Rockville, MD: U. S Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.