Skip to main content

Advertisement

SpringerLink
Log in

Utilization of Mental Health Services by Minority Urban Adults: Psychosocial Predictors

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. A structural equation model controlling for the participants’ gender, educational level in emerging adulthood, and age at the most recent data collection showed significant standardized pathways from both ethnicity (β = −0.28; z = −4.82; p < 0.001) and psychological symptoms (β = 0.15; z = 2.41; p < 0.05), both measured in emerging adulthood, to smoking in the early 30s. That, in turn, was associated with certain physical diseases and symptoms (i.e., respiratory) in the mid-30s (β = 0.16; z = 2.59; p < 0.05). These physical diseases and symptoms had a cross-sectional association with family financial difficulty in the mid-30s (β = 0.21; z = 4.53; p < 0.001), which in turn also had a cross-sectional association with psychiatric disorders (β = 0.30; z = 5.30; p < 0.001). Psychiatric disorders had a cross-sectional association with mental health services utilization (β = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1

Similar content being viewed by others

References

  1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas LR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 539–602.

    Google Scholar 

  2. Bauer AM, Chen CN, Alegria M. Associations of physical symptoms with perceived need for and use of mental health services among Latino and Asian Americans. Soc Sci Med. 2012; 75(6): 1128–33.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Fenta H, Hyman I, Noh S. Mental health service utilization by Ethiopian immigrants and refugees in Toronto. J Nerv Ment Dis. 2006; 194(12): 925–34.

    Article  PubMed  Google Scholar 

  4. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 629–40.

    Article  PubMed  Google Scholar 

  5. Yoon J, Bernell SL. The role of adverse physical health events on the utilization of mental health services. Health Serv Res. 2013; 48(1): 175–94.

    Article  PubMed  Google Scholar 

  6. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995; 36(1): 1–10.

    Article  CAS  PubMed  Google Scholar 

  7. Andrews B, Hejdenberg J, Wilding J. Student anxiety and depression: comparison of questionnaire and interview assessments. J Affect Disord. 2006; 95(1–3): 29–34.

    Article  PubMed  Google Scholar 

  8. Andrews B, Wilding JM. The relation of depression and anxiety to life-stress and achievement in students. Br J Psychol. 2004; 95(Pt 4): 509–21.

    Article  PubMed  Google Scholar 

  9. Mowbray CT, Megivern D, Mandiberg JM, et al. Campus mental health services: recommendations for change. Am J Orthopsychiatry. 2006; 76(2): 226–37.

    Article  PubMed  Google Scholar 

  10. Center for Disease Control and Prevention (CDC). Early Release of Selected Estimates Based on Data from the January–June 2013 National Health Interview Survey. http://www.cdc.gov/nchs/nhis/released201212.htm. December 13, 2012. Accessed December 16, 2013.

  11. Caraballo RS, Yee SL, Gfroerer J, Mirza SA. Adult tobacco use among racial and ethnic groups living in the United States, 2002–2005. Prev Chronic Dis. 2008; 5(3): A78.

    PubMed Central  PubMed  Google Scholar 

  12. Centers for Disease Control Prevention (CDC). Chemical suicides in automobiles—six states, 2006–2010. MMWR Morb Mortal Wkly Rep. 2011; 60(35): 1189.

    Google Scholar 

  13. Vital and Health Statistics. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2008. Series 10 (Number 242). http://www.cdc.gov/nchs/data/series/sr_10/sr10_242.pdf. December 2009. Accessed January 7, 2014.

  14. Brook DW, Brook JS, Zhang C, Whiteman M, Cohen P, Finch SJ. Developmental trajectories of cigarette smoking from adolescence to the early thirties: personality and behavioral risk factors. Nicotine Tob Res. 2008; 10(8): 1283–91.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Brook A, Zhang C. The role of personal attributes in the genesis and progression of lung disease and cigarette smoking. Am J Public Health. 2013; 103(5): 931–7.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life loss, and productivity losses-United States, 2000–2004. MMWR Morb Mortal Wkly Rep. 2008; 57(45): 1226–8.

    Google Scholar 

  17. Department of Health & Human Services. Surgeon General’s Report—How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis For Smoking-Attributable Disease. Atlanta, GA: US Centers for Disease Control and Prevention; 2010.

    Google Scholar 

  18. Dickerson JB, Smith ML, Ahn S, Ory MG. Associations between health care factors and self-reported health status among individuals with diabetes: results from a community assessment. J Community Health. 2011; 32(2): 332–41.

    Article  Google Scholar 

  19. Matthews KA, Gallo LC. Psychological perspectives on pathways linking socioeconomic status and physical health. Annu Rev Psychol. 2011; 62: 501–30.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Tinkelman DG, George D, Halbert RJ. Chronic obstructive pulmonary disease in patients under age 65: utilization and costs from a managed care sample. J Occup Environ Med. 2005; 47(11): 1125–30.

    Article  PubMed  Google Scholar 

  21. Yelin E, Katz P, Balmes J, et al. Work life of persons with asthma, rhinitis, and COPD: a study using a national, population-based sample. J Occup Med Toxicol. 2006; 1: 2.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Hoelzl E, Pollai M, Kamleitner B. Experience, prediction and recollection of loan burden. J Econ Psychol. 2009; 30(3): 446–54.

    Article  Google Scholar 

  23. Santiago CD, Wadsworth ME, Stump J. Socioeconomic status, neighborhood disadvantage, and poverty-related stress: prospective effects on psychological syndromes among diverse low-income families. J Econ Psychol. 2011; 32(2): 218–30.

    Article  Google Scholar 

  24. Lund C, Breen A, Flisher AJ, et al. Poverty and common mental disorders in low and middle income countries: a systematic review. Soc Sci Med. 2010; 71(3): 517–28.

    Article  PubMed  Google Scholar 

  25. Selenko E, Batinic B. Beyond debt. A moderator analysis of the relationship between perceived financial strain and mental health. Soc Sci Med. 2011; 73(12): 1725–32.

    Article  PubMed  Google Scholar 

  26. Olfson M, Liu S-M, Grant BF, Blanco C. Influence of comorbid mental disorders on time to seeking treatment for major depressive disorder. Med Care. 2012; 50(3): 227–32.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Seal KH, Maguen S, Cohen B, et al. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress. 2010; 23(1): 5–16.

    PubMed  Google Scholar 

  28. Putman-Casdorph H, McCrone S. Chronic obstructive pulmonary disease, anxiety, and depression: state of the science. Heart Lung. 2009; 38(1): 34–47.

    Article  PubMed  Google Scholar 

  29. Rumsfeld J, Havranek E, Masoudi F, et al. Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003; 42(10): 1811–7.

    Article  PubMed  Google Scholar 

  30. Kunik ME, Roundy K, Veazey C, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005; 127(4): 1205–11.

    Article  PubMed  Google Scholar 

  31. Schane RE, Walter LC, Dinno A, Covinsky KE, Woodruff PG. Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease. J Gen Intern Med. 2008; 23(11): 1757–62.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Bachman JG, O’Malley PM, Schulenberg JE, Johnston LD, Freedman-Doan P, Messersmith EE. The Education–Drug Use Connection: How Successes and Failures in School Relate to Adolescent Smoking, Drinking, Drug Use, and Delinquency. Mahwah, NJ: Erlbaum; 2008.

    Google Scholar 

  33. Bryant AL, Schulenberg JE, O’Malley PM, Bachman JG, Johnston LD. How academic achievement, attitudes, and behaviors related to the course of substance use during adolescence: a 6-year, multiwave national longitudinal study. J Res Adolesc. 2003; 13(3): 361–97.

    Article  Google Scholar 

  34. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national survey results on drug use, 1975–2005. Vol I (NIH Publication No. 06–5883). Bethesda, MD: National Institute on Drug Abuse; 2006.

    Google Scholar 

  35. Bertakis KD, Azari R, Helms J, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000; 49(2): 147–52.

    CAS  PubMed  Google Scholar 

  36. Hatzenbuehler ML, Keyes KM, Narrow WE, Grant BF, Hasin DS. Racial/ethnic disparities in service utilization for individuals with co-occurring mental health and substance use disorders in the general population. J Clin Psychiatry. 2008; 69(7): 1112–21.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Guendelman S, Wagner TH. Health services utilization among Latinos and white non-Latinos: results from a national survey. J Health Care Poor Underserved. 2000; 11(2): 179–94.

    Article  CAS  PubMed  Google Scholar 

  38. Brook JS, Hamburg BA, Balka EB, Wynn PS. Sequences of drug involvement in African-American and Puerto Rican adolescents. Psychol Rep. 1992; 71(1): 179–82.

    Article  CAS  PubMed  Google Scholar 

  39. Brook JS, Whiteman M, Balka EB, Win PT, Gursen MD. African-American and Puerto Rican drug use: a longitudinal study. J Am Acad Child Adolesc Psychiatry. 1997; 36(9): 1260–8.

    Article  CAS  PubMed  Google Scholar 

  40. Derogatis LR. Symptoms Checklist 90-R: Administration Scoring, and Procedures Manual. 3rd ed. Minneapolis, MN: National Computer Systems; 1994.

    Google Scholar 

  41. Hilton JM, Devall EL. The Family Economic Strain Scale (FESS): development and evaluation of the instrument with single- and two- parent families. J Fam Econ Issues. 1997; 18(3): 247–72.

    Article  Google Scholar 

  42. Perron R. Recession Takes Toll on Hispanics 45+: Boomers Particularly Hard Hit. Washington DC: AARP; http://assets.aarp.org/rgcenter/econ/hispeconomy.pdf. March 2010. Accessed July 2012.

  43. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998; 59(Suppl 20): 22–33.

    PubMed  Google Scholar 

  44. Sheehan DV, Janavs J, Baker R, Harnett-Sheehan K, Knapp E, Sheehan M. MINI International Neuropsychiatric Interview (English version 5.0.0) for DSM-IV. Tampa, FL: University of South Florida; 2006.

    Google Scholar 

  45. Ruggiero KJ, Ben KD, Scotti JR, Rabalais AE. Psychometric properties of the PTSD checklist—civilian version. J Trauma Stress. 2003; 16(5): 495–502.

    Article  PubMed  Google Scholar 

  46. Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the Annual Meeting of the International Society for Traumatic Stress Studies. October 1993; San Antonio, TX

  47. Muthén LK, Muthén BO. Mplus users’ guide. 6th ed. Los Angeles, CA: Muthén & Muthén; 2010.

    Google Scholar 

  48. Newcomb MD, Bentler PM. Impact of adolescent drug use and social support on problems of young adults: a longitudinal study. J Abnorm Psychol. 1988; 97(1): 64–75.

    Article  CAS  PubMed  Google Scholar 

  49. Bentler PM. On tests and indices for evaluating structural models. Pers Individ Dif. 2007; 42(5): 825–9.

    Article  Google Scholar 

  50. Kelloway KE. Using LISREL for Structural Equation Modeling: A Researcher’s Guide. Thousand Oaks, CA: Sage Publications; 1998.

    Google Scholar 

  51. Byrne BM. Structural Equation Modeling with LISREL, RELIS and SIMPLIS: Basic Concepts, Applications and Programming. Mahwah, NJ: Lawrence Erlbaum Associates; 1998.

    Google Scholar 

  52. Diamantopoulos A, Siguaw JA. Introducing LISREL. London, UK: Sage Publications; 2000.

    Google Scholar 

  53. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6): 1173–82.

    Article  CAS  PubMed  Google Scholar 

  54. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivar Behav Res. 2004; 39(1): 99–128.

    Article  Google Scholar 

  55. Muthén B, Kaplan D, Hollis M. On structural equation modeling with data that are not missing completely at random. Psychometrika. 1987; 52(3): 431–62.

    Article  Google Scholar 

  56. Kubzansky LD, Sparrow D, Jackson B, Cohen S, Weiss ST, Wright RJ. Angry breathing: a prospective study of hostility and lung function in the Normative Aging Study. Thorax. 2006; 61(10): 863–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Drentea P, Lavrakas PJ. Over the limit: the association among health, race and debt. Soc Sci Med. 2000; 50(4): 517–29.

    Article  CAS  PubMed  Google Scholar 

  58. Reading R, Reynolds S. Debt, social disadvantage and maternal depression. Soc Sci Med. 2001; 53(4): 441–53.

    Article  CAS  PubMed  Google Scholar 

  59. Hammen C, Kim E, Eberhart NK, Brennan PA. Chronic and acute stress and the prediction of major depression in women. Depress Anxiety. 2009; 26(8): 718–23.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Kwag KH, Martin P, Russell D, Franke W, Kohut M. The impact of perceived stress, social support, and home-based physical activity on mental health among older adults. Int J Aging Hum Dev. 2011; 72(2): 137–54.

    Article  PubMed  Google Scholar 

  61. Brook JS, Balka EB, Crossman AM, Dermatis H, Galanter M, Brook DW. The relationship between parental alcohol use, early and late adolescent alcohol use, and young adult psychological symptoms: a longitudinal study. Am J Addict. 2010; 19(6): 534–42.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Woodward LJ, Fergusson DM. Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry. 2001; 40(9): 1086–93.

    Article  CAS  PubMed  Google Scholar 

  63. Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental health problems and needs in a college student population. J Affect Disord. 2009; 117(3): 180–5.

    Article  PubMed  Google Scholar 

  64. Harrison L, Martin S, Enev T, Harrington D. Comparing drug testing and self-report of drug use among youths and young adults in the general population. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2007. (DHHS Publication No. SMA 07–4249, Methodology Series M-7)

  65. Vartiainen E, Seppälä T, Lillsunde P, Puska P. Validation of self reported smoking by serum cotinine measurement in a community-based study. J Epidemiol Community Health. 2002; 56(3): 167–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  66. Bigos KL, Mattay VS, Callicott JH, et al. Genetic variation in CACNA1C affects brain circuitries related to mental illness. Arch Gen Psychiatry. 2010; 6(9): 939–45.

    Article  Google Scholar 

  67. Sinclair RR, Sears LE, Probst T, Zajack M. A multilevel model of economic stress and employee well-being. In: Houdmont J, Leka S, eds. Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice. Chichester, UK: Wiley-Blackwell; 2010: 1–20.

    Chapter  Google Scholar 

Download references

Acknowledgments

This research was supported by National Institutes of Health research grant DA005702, and Research Scientist Award DA000244, both from the National Institute on Drug Abuse, awarded to Dr. Judith S. Brook.

Author information

Authors and Affiliations

  1. Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Fl., New York, NY, 10016, USA

    Judith S. Brook, Jung Yeon Lee, Elinor B. Balka & David W. Brook

  2. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Stephen J. Finch

Authors
  1. Judith S. Brook
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung Yeon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elinor B. Balka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen J. Finch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David W. Brook
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Judith S. Brook.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brook, J.S., Lee, J.Y., Balka, E.B. et al. Utilization of Mental Health Services by Minority Urban Adults: Psychosocial Predictors. J Urban Health 91, 720–735 (2014). https://doi.org/10.1007/s11524-014-9878-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-014-9878-3

Keywords

Search

Navigation