The Effects of Perceived Racial Discrimination In the Medical Encounter On Utilization of Health Services Among People with Serious Mental Illness: Results From the California Health Interview Survey

Background: People living with serious mental illness (SMI) are vulnerable to disparities in health and health service use and experience on average 25 years more of lost life compared to the general population. Some minorities with SMI have higher rates of diabetes and obesity compared to non-Hispanic whites with SMI, but are less likely to utilize health services needed to manage chronic conditions. There is limited understanding of the factors that contribute to this disparity. Studies have shown that perceived racial and ethnic discrimination in the medical encounter contributes to fewer medical visits in the general population. The purpose of this study is to examine the effects of racial discrimination in the medical encounter on use of physical health services among adults with SMI.

Methods: A sample of 1528 adults with severe psychological distress was taken from the 2001 wave of the California Health Interview Survey: a population based telephone survey that is representative of California adults. All responses were based on self-reports. Perceived discrimination was assessed using the question: Have you ever felt that you would have received better medical care if you belonged to a different race or ethnicity. Other independent variables used in the model were guided by Andersen's Model of Health Service Utilization and included predisposing, enabling, and need factors. OLS regression analysis was used to test associations between the independent variables and number of medical visits in the past year.

Results: The experience of racial or ethnic discrimination in the medical encounter one year ago or more is significantly associated a decreased number of visits to the medical doctor in the past year (p<.001). Being Latino was also associated with a decrease in number of medical visits in the last year (p <.05). Being Asian was associated with decrease in medical visits (p <.01). Respondents who had cognitive and functional impairments experienced an increase in number of medical visits in the past year (p<.05). Not having insurance was associated with a decrease in health service use (p<.001) An increase in days of poor physical health in the past year was also associated with a increase in number of medical visits in the last year (p<.001)

Discussion: These findings could provide targets that inform the development of interventions used to enhance patient provider communication. Providers should be aware that perceived racial/ethnic discrimination in the medical encounter is associated with decreased use of medical services for adults living with SMI. Providers should be aware that Asians and Latinos with SMI might face additional barriers in utilizing health services, and might need extra culturally competent supports in assisting them to access health services. Finally, because people with additional functional impairments might also have additional social service supports in place that facilitate the use of medical services, people with SMI but without major functional impairments might be at greater risk for under-utilizing health services.