Mental Health Service Use of Older Latinos: Understanding of Role of County Context

Background/Purpose: Although older Latinos experience high rates of depression, they tend to underuse mental health services compared to their White counterparts. Previous literature has typically examined the role of individual-level characteristics (e.g., socioeconomic status, mental health status, acculturation) to understand mental health service utilization in this population. However, limited attention has been given to geographic differences as contributing factors to racial and ethnic disparities in mental health care. For example, older Latinos are more likely to live in economically disadvantaged areas that have fewer mental health care resources and services, but this remains understudied. To address this gap in the literature, our study examined the association between county characteristics and mental health service use among older Latinos, controlling for individual characteristics.

Method: We used the 2008-2012 Medical Expenditure Panel Study (MEPS) and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Latinos ages 60 or older (level 1)and 156 counties (level 2)where the sample resides.

We measured the dependent dichotomous variable based on whether 1) the respondent received care from a mental health professional, 2) the service received included mental health counseling or psychotherapy, and 3) the service received was related to the International Classification of Diseases, ninth revision codes. To measure county context, we used county-level predisposing (e.g., proportion of older adults, percent Latino population, metropolitan area), enabling (e.g., existence of community mental health center, health professional shortage area, hospital with social work services, mental health professionals per 100,000, median home value), and need (e.g., mortality rate, depression rate). We adjusted for individual characteristics (e.g., age, gender, marital status, education, poverty, attitude toward health, health insurance, and mental health status). We employed multilevel logistic regression analysis.

Results: The existence of community mental health centers (OR = 3.86, p = .001), primary care physician shortage area (OR = 2.64, p = 0.004), number of hospitals with social work services (OR = 0.97, p = 0.016), and median home value (OR = 1.004, p = 0.022) at the county-level was associated with mental health services use among this population. In addition, women, younger older adults, those with a high school diploma, and those who have worse mental health status had higher odds of using mental health services.

Conclusions and Implications: Our study indicates that the county context plays an important role in understanding mental health services use among older Latinos, indicating the need for intervention strategies at the macro level. Social work practitioners and policy makers may identify counties most in need of outreach. For example, they can provide outreach counseling services or educational programs in a county without community mental health centers. Counties are socioeconomically heterogeneous regions, so future research should look into differences between high- and low-income individuals with the same county.