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Mental Health Service Use Among Older African Americans: The National Survey of American Life

https://doi.org/10.1097/JGP.0b013e318187ddd3Get rights and content

Objectives

The objective of this study was to examine mental health services utilization of older African Americans using data from the National Survey of American Life.

Methods

A subsample of African American respondents aged 55 years or older (N = 837) was used for this study. Thirteen mental disorders, including mood, anxiety, and substance disorders, were assessed using the Diagnostic Statistical Manual-IV World Mental Health Composite International Diagnostic Interview. Seventy-four respondents (9.6%) met criteria for a disorder. Self-reported service use included psychiatric and nonpsychiatric mental health services, general medical care, and nonhealth care (e.g., human services and complementary-alternative medicine).

Results

Overall, 46.5% (N = 30) of older African Americans with any one 12-month disorder used some form of services in the last year; 47.2% (N = 12) with two or more disorders used any services. Those reporting any mood disorder had higher service use in every sector compared with those with any anxiety or any substance disorder. Age was significantly related with each service sector except for nonhealth care. There were no significant gender or work status differences, and marital status was only significant in nonhealth care use. Those aged 55–64, married, and not residing in the south were more likely to report any service use than their respective counterparts.

Conclusions

These findings reveal that a significant proportion of African American older adults with mental health disorders do not receive professional help. Future research on system, provider, and patient factors is needed to clarify and explain underutilization of mental health services.

Section snippets

Sample

The NSAL is a national multistage probability sample in the continental United States. Data were collected by the University of Michigan's Institute for Social Research Survey Research Center on behalf of the Program for Research on Black Americans. Data were collected from February 2001 to June 2003 using face-to-face computer-assisted interviews. Interviewers participated in a 10-day training program and were closely supervised throughout the data-collection period. Initial interviews and

RESULTS

Overall, 7.3% (N = 54) of older African Americans obtained services in response to problems with their emotions, mental health, or use of alcohol or drugs. The demographic correlates of 12-month service use are presented in Table 1. Those aged 55–64 years reported using more general medical care and mental health services compared with nonhealth care options. Use of any services, mental health services, and general medical care was lower among those 65 years or older. Age showed no significant

DISCUSSION

Among older African Americans more than half of respondents with a mental disorder did not use services, suggesting a substantial amount of unmet need among this population, although we do not know if everyone who meets criteria for a disorder has a need for treatment. In addition, 3% of those without a disorder reported using services. These may be individuals with subsyndromal disorders, individuals who are in recovery, or those with other issues for which they are seeking treatment, such as

References (35)

  • WE Narrow et al.

    Mental health service use by Americans with severe mental illnesses

    Soc Psychiatry Psychiatr Epidemiol

    (2000)
  • L Cooper-Patrick et al.

    Mental health service utilization by African Americans and Whites: The Baltimore Epidemiologic Catchment Area Follow-Up

    Med Care

    (1999)
  • DA Regier et al.

    The epidemiology of mental disorder treatment need: Community estimates of ‘medical necessity’

  • DA Regier et al.

    The de facto US mental and addictive disorders service system: Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services

    Arch Gen Psychiatry

    (1993)
  • U. S. Department of Health and Human Services: Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental...
  • DK Padgett et al.

    Ethnicity and the use of outpatient mental health services in a national insured population

    Am J Public Health

    (1994)
  • LR Snowden et al.

    Frequency and scope of mental health service delivery to African Americans in primary care

    Ment Health Serv Res

    (2002)
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    This work was supported by the National Institute of Mental Health (NIMH; U01-MH57716) with supplemental support from the Office of Behavioral and Social Science Research at the National Institutes of Health (NIH) and the University of Michigan, the National Institute on Aging to Taylor (R01-AG18782), and Drs. Jackson and Taylor (P30-AG15281). Dr. Neighbors is also supported by a Health Policy Scholars Award from the Robert Wood Johnson Foundation.

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