Regular Research Article
Bridging the Gap Between Common Mental Disorders and Service Use: The Role of Self-Rated Mental Health Among African Americans

https://doi.org/10.1016/j.jagp.2014.02.010Get rights and content

Objective

The unmet need for mental health care in racial/ethnic minorities has been a major public health concern. Using a sample of African Americans, this study questioned whether self-rated mental health (SRMH), an individual's subjective assessment of personal mental and emotional status, modifies the link between mental disorders and service use.

Design

Cross-sectional analyses of the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005–2006.

Setting

In-home personal interviews.

Participants

Self-identified African American/black participants aged 40 to 85 years (N = 460).

Measurements

Participants were assessed if they met the diagnostic criteria for three common mental disorders (major depression, generalized anxiety disorder, and panic disorder) in the prior 12 months, using the Composite International Diagnostic Interview (CIDI). Response to a single-item SRMH was dichotomized (excellent/very good/good or fair/poor). Service use was indicated by the use of any services in the past year (mental health specialist, general doctor, and clergy).

Results

Multivariate analyses identified a significant interaction between mental disorder and SRMH in predicting service use. The likelihood of service use increased substantially when individuals with a disorder reported their mental health to be fair/poor.

Conclusions

Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors. Findings suggest that interventions that enhance an individual's self-awareness of mental health problems may help bridge the gap between mental health care needs and service use in African Americans.

Section snippets

Data

The data were from the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005–2006.22 Using a stratified area probability sampling, data were collected from 79 census tracts with populations at least 40% African American in Milwaukee County, Wisconsin. The census blocks were stratified by income, with roughly half coming from tracts in which the median household income was $40,000 or greater, and the remainder coming from tracts in which the

Descriptive Information of the Sample

Table 1 summarizes descriptive information on the sample and study variables. The sample included 460 participants, aged between 40 and 85 years, with an average age of 54.9 years (SD: 10.6). More than half of the participants were women (62%). About 30% were married, and 76% received a high school education or more. Approximately 78% had health insurance that covered mental health service use, and more than half of the sample (52.6%) had three or more chronic medical conditions. The overall

Discussion

Responding to the historical mental health care disparities in African Americans,1, 3, 4, 5, 6, 7 the present study conceptualized self-rated mental health as a potential factor that may help explain the gap between mental disorder and service use. An individual's subjective appraisal of mental health status is considered to be a critical part of help-seeking decision-making that determines the path regarding whether the presence of mental disorder is linked to the use of services.11, 12, 13

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