Factors Associated with American Indian Mental Health Service Use in Comparison with White Older Adults

Background and Purpose

Racial/ethnic disparities in mental health service use have increasingly captured national attention.  Existing data indicate that American Indian and Alaska Native (AI/AN) populations disproportionately suffer from a range of mental health problems and are at greater risk for mental illnesses than other racial/ethnic groups. Despite the severity of mental health challenges, very low rates of mental health service use tend to be reported across these older adult populations, with some variation in help-seeking rates across gender, tribe, and region.  In addition, when seeking professional help, many AI/AN older adults may experience discomfort and cultural incongruence from the available providers and treatment methods, making treatment attrition a challenge. Despite the rapid growth of the nation’s elderly populations and persistent disparities in AI/AN mental health service use, little is known about the racial/ethnic, cultural, and attitudinal factors affecting the gaps in mental health service utilization, particularly among AI/AN older adults. Thus, we examined factors associated with mental health service use in AI and White older adults using the Gilber, Andersen, and Leak’s behavioral health model for vulnerable populations (2000).  We hypothesized that relative to White, AI will report lower level of mental health service utilization. We also hypothesized that different factors will impact mental health service utilization between AI and White older adults. To the best of our knowledge, this is one of the few efforts to date to compare factors affecting utilization of mental health service in a rural sample of AI and White older adults.

Methods

            We used a cross-sectional design with self-administered surveys with a convenience sample of 755 rural and urban adults (50+) in South Dakota (n=502/Whites, n=233 AIs). Ordinal regression was used to examine the extent to which predisposing (age, race, adverse childhood experience), need (depressive symptoms, physical health), and enabling/-hindering factors (prior mental health service experience, depression literacy, perceived stigma, attitude toward mental health service, income) predicted the level of mental health service utilization.

Results

White older adults used more mental health services compared to AI older adults. AIs were more likely to report negative experiences with mental health services. For both groups, more adverse childhood experiences and prior negative experience with mental health service use were significantly related to an increased level of mental health service use. Compared to their White counterparts, AI older adults who reported a higher level of depressive symptoms, better self-perceived physical health, and a more positive attitude toward mental health services tended to use more mental health services.

Conclusion and Implications

Our results indicate culturally specific outcomes regarding mental health service utilization and that culturally specific and targeted intervention that are holistic and relevant to AIs are highly needed. To reduce mental health disparities among AI older adults, community, local government, and academic partners should pay attention to how to encourage the use of mental health services, which meet th