Development Matters: Comparing Family Influences on Mental Health Service Utilization for African American Emerging and Middle-Aged Adults

Background and Purpose: Understanding factors associated with mental health service utilization is important for creating, promoting, and delivering interventions. While many studies have focused on the role of predisposing need and enabling factors based on Andersen’s model, recent studies show that social networks are also important for understanding patterns of mental health service utilization. Yet, studies have rarely considered developmental stages when examining the association between social networks and mental health services use. One’s social network changes throughout the life course. In particular, emerging adulthood is marked by instability and transition; thus, the influences of family during emerging adulthood are likely different than in middle adulthood. To that end, the purpose of this study is to examine whether family influences on the use of mental health services differ for African American adults at two different developmental stages—emerging and middle adulthood.

Methods: Data and samples: We used the National Survey of American Life, a nationally representative dataset, and restricted our sample to 3,570 African American respondents.  

Measures: Use of mental health services was operationalized as receiving any types of services for “problems with emotions, mental health, or use of alcohol or drugs” in the past 12 months. Services options included inpatient and outpatient counseling, receiving prescription medication, self-help groups, internet support groups, and hotlines. Family influence was operationalized by measures of emotional support from family and negative interactions with family. Emotional support was the sum of two four-point Likert scales, and negative interactions scores were the sum of three four-point Likert scales. Emerging adults were individuals aged 18 to 29 and middle-aged adults were individuals aged 45 to 64. Logistic regression analyses tested the relationship between family influences and mental health service use, while controlling for sex, marital status, employment status, education, income, insurance, and the level of psychological distress.

Results: Logistic regression results for the total sample indicated that both emotional support (OR=.92, 95% CI=.85-.99) and negative interactions (OR=1.07, 95% CI=1.04-1.12) were associated with the use of mental health services. Subsequent analyses examining emerging adults and middle-aged adults separately revealed different patterns of association. Specifically, for emerging adults, negative interactions (OR=1.13, 95% CI=1.02-1.26) were positively associated with the use of mental health service while emotional support was not statistically significant. For middle-aged adults, emotional support was negatively associated with the use of mental health services (OR=.86, 95% CI=.77-.96) while negative interactions were not statistically significant.  

Conclusions and Implications: The findings suggest that the ways in which family influences relate to mental health service use by African Americans vary by developmental stage. While negative interactions with family may be more relevant to understanding mental health service utilization for African American emerging adults, emotional support from family may be more important to understanding the service utilization of middle-aged African American adults. Efforts to increase mental health service utilization for African American adults should consider both family influences and developmental stages in their design and implementation.