Is the Quitting Mental Health Treatment Services Proportional Among Racial and Ethnic Groups of Americans?

Background and Purpose: Depression is a major mental health disorder that impacts all racial and ethnic groups in the United States. However, Black Americans are more likely to quit mental health treatment services for depression prior to the recommended course of treatment than Non-Hispanic White Americans. Yet it is not clear whether this pattern is generalizable to other racial/ethnic minorities, and whether the reasons for quitting are similar across racial/ethnic minorities. In this study, we examine quitting treatment of 9 types of mental health services among Black, Hispanic, Asian, and Non-Hispanic White Americans. A multivariate logistic regression model examined odds of quitting for each racial/ethnic group, controlling for social and clinical correlates. Bivariate differences in the reasons given for quitting between each racial/ethnic group were also examined.

Methods: From the nationally representative 2001-2003 Collaborative Psychiatric Epidemiology Surveys (CPES), 2,940 participants were identified as having a major depressive episode at some point in their life, representing the overall sample for this study. Participants were asked whether they utilized 9 types of mental health treatment services at some point in their life (psychiatrist, social worker, medical doctor, etc.), and whether they quit treatment prior to service provider recommendations. Additionally, participants reported social and clinical characteristics including race/ethnicity, age, gender, marital status, and household annual income, and the presence of a lifetime major depressive, anxiety, alcohol use, or drug use disorder, consistent with DSM-IV criteria. Finally, participants who reported they quit mental health treatment were asked among 16 reasons why they quit. Logistic regression examined odds of quitting mental health treatment for each racial/ethnic group, and chi-square analyses examined whether reasons for quitting differed by participant’s race/ethnicity. All analyses incorporated survey weights provided in the CPES. 

Results: Among respondents, 40% reported they had quit a mental health treatment at some point in their lives. Results showed that Black and Hispanic Americans were significantly more likely to quit treatment with psychiatrists, social workers, and spiritual advisors compared to White Non-Hispanic Americans. Finally, participants cited they “got better,” “wanted to handle the problem on their own,” and “didn’t need help anymore” as the top reasons they quit. While bivariate associations were not significant, a larger proportion of Black Americans endorsed these reasons for quitting compared to Whites.

Conclusions and Implications: While a large percentage of individuals who have had a major depressive episode quit treatment prior to service provider recommendations, for some forms of treatment, racial and ethnic minorities are more likely to quit than Non-Latino White Americans. These findings have implications for social work practice and policy. In terms of social work practice, increased efforts are needed to intervene early to retain clients of diverse racial and ethnic backgrounds. In terms of social work policy, efforts should be directed towards making services more accessible by removing the barriers associated with quitting treatment prior to service provider recommendations.