Self-Rated Mental Health As a Facilitator of Mental Health Service Use in African Americans

Purpose.  A gap between the presence or severity of psychiatric disorder (“need”) and mental health service use has been persistent over the past decades.  The unmet need of mental health care is particularly pronounced among racial/ethnic minorities.  African Americans, for example, have a lower likelihood of receiving mental health treatment than non-Hispanic Whites even after controlling for differences in sociodemographic characteristics and psychiatric disorders.  Using a sample of African Americans, this study examined whether the link between psychiatric disorders and mental health service use is modified by self-rated mental health (SRMH), an individual’s subjective assessment of personal mental and emotional status.  We conceptualized SRMH as a critical factor in the mental health care seeking process which makes individuals recognize the need and seek help.

Methods.  The data were from the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005-2006.  Self-identified African Americans/Blacks aged 40 to 85 (n=460) were included in the analyses.  The direct and interactive effects of psychiatric disorders (the presence of any major depression, generalized anxiety disorder, or panic disorder measured by DSM-III-R) and SRMH (excellent/very good/good or fair/poor) on the use of any mental health services in the past year (psychiatrists, general doctors, mental health counselors, and clergy) were examined by hierarchical logistic regression models.   

Results.  The proportion of individuals with any psychiatric disorder was 12.2%.  Among them, only 55.4% had used mental health services in the past year.  In the multivariate model of mental health service use, both the presence of psychiatric disorders (OR = 4.11, p < .001) and poor ratings of SRMH (OR = 2.09, p < .05) were found to have a direct effect.  Furthermore, the interaction between psychiatric disorders and SRMH (OR = 5.78, p < .05) was shown to be significant. The predictability of the presence of disorder to service use varied substantially by SRMH: the odds of receiving any services were 8.70 (95% CI = 3.01, 25.1, p < .01) for those with a fair/poor SRMH, but only 1.72 (95% CI = 0.74, 3.98, p>.05) for those with an excellent/very good/good SRMH.    

Implications.  Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors.  The finding shows that the mismatch between one’s objective mental health status and subjective assessment poses a critical barrier to service use and call attention to SRMH as an intervening agent that can promote mental health service use.  Given that service use is actualized when individuals perceive the need for care, intervention efforts should focus on ways to promote self-recognition and awareness of mental health issues among African Americans.