Research on racial and ethnic disparities in mental health service utilization remains unclear. A 2001 US Department of Health and Human Services national report of mental health suggests that African Americans have lower rates of service utilization than Hispanic and Non-Hispanic Whites. Through previous research, it is shown that the increased stress accompanying perceived discrimination leads to higher rates of medical and mental health problem severity. However, it is unclear whether perceived discrimination can also impact mental health service utilization. The purpose of this study is to examine the relationship between experiencing discriminatory attitudes and service utilization in a sample of African Americans with depressive symptoms. It is hypothesized that when controlling for previously identified demographic factors explaining service utilization, experiencing discriminatory attitudes contributes to service utilization differences among African Americans.
This study used data collected from the National Survey of American Life (NSAL), a national household probability sample of African Americans, non-Hispanic Whites, and Blacks of Caribbean dissent. Our sample consisted of 289 African American participants (born in the US) who reported that they had experienced depressive symptoms at some point in their lives. The dependent binary variable used in the analysis examined whether a participant with depressive symptoms had ever sought help from a medical professional in their lifetime. Our main independent variable used in the analysis was a continuous 6-point variable, ranging from “never” to “almost everyday”, that asked: “In your day-to-day life, how often are you treated with less respect than others”. A binary logistic regression was used to examine whether being treated with less respect than others predicted mental health services utilization for depression, when controlling for the known factors of age, education, marital status, and gender.
The overall model correctly predicted 68.6% of all cases and accounted for 15.9% of the variance in our dependent variable (Nagelkerke R square = .159). The results showed that marital status, gender, and being treated with less respect were all significant predictors of mental health service utilization. Results showed that never married participants were less likely to seek help for depressive symptoms than both married/cohabitating and divorced/separated/widowed participants (OR=.430, 95% CI=.217-.853). Also, women had lower odds of service utilization than men (OR=.390, 95% CI=.213-.714). Finally, participants experiencing higher levels of being treated with less respect showed lower odds of service utilization (OR=.772, 95% CI=.614-.971). Both age and education were non-significant in the regression model.
Conclusions and Implications:
This study provides new information for social workers in terms of policy formation and outreach/organization efforts. As efforts are undertaken to remedy disparities in mental health service utilization by race/ethnicity, specific efforts must be directed towards addressing the role of demographic factors, such as gender and marital status, in pursuing mental health treatment. Considerable effort must also be directed towards addressing the discriminatory attitudes persons in need of mental health treatment experience in their everyday lives.