Minority Health: Recent Findings 4 ► Mental/Behavioral Health

Minority Health: Recent Findings

Mental/Behavioral Health

• Research finds a link between PTSD and elevated blood sugar in low income minorities. Researchers studied 103 low income minority patients with type 2 diabetes who were being treated at one of four community-based primary care clinics in Harlem. They found that 12 percent of these men and women had full posttraumatic stress disorder (PTSD), and another 12 percent had subthreshold PTSD. The most common sources of trauma were childhood physical abuse (22 percent) and the death of a child (18 percent). Those who had full PTSD were significantly more likely to have an elevated HBA1C level. Patients with PTSD also were more likely to suffer from depressive symptoms and to be taking a psychiatric medication.
  Source: Miller, Mancuso, Boutin-Foster, et al., Gen Hosp Psychiatry 33:116-122, 2011 (AHRQ grant T32 HS00066).

• Among adolescents, whites are much more likely than blacks or Hispanics to use antidepressants. According to this analysis of data from AHRQ's Medical Expenditure Panel Survey, white adolescents are more than twice as likely as Hispanic adolescents and almost five times as likely as black adolescents to use antidepressants. The researchers note that much of the Hispanic/white gap may be explained by two-parent families, family income, education, health insurance, and having a usual source of care. On the other hand, the black/white gap may be due in part to the way minorities perceive mental health difficulties and the use of antidepressants by adolescents.
  Source: Kirby, Hudson, and Miller, Med Care Res Rev 67(3):342-363, 2010 (AHRQ Publication No. 10-R072).* See also Hudson, Miller, and Kirby, Med Care 45(11):1068-1075, 2007 (AHRQ Publication No. 08-R044)* (lntramural).

• Less-accultured Latinos use fewer mental health services than others. AAn analysis of data on use of mental health services by the three largest Latino groups in the Nation (Mexicans, Cubans, and Puerto Ricans) revealed that those who were less accultured and more medically self-reliant used fewer mental health services than others. Mexicans (4.5 percent) and Cubans (5.7 percent) were less likely than whites (9.3 percent) to use any mental health service, but use by Puerto Ricans (8.3 percent) was not significantly different from that of whites. Lower English language proficiency and less time spent in the United States were associated with the lowest use of mental health services.
  Source: Berdahl and Torres Stone, Community Ment Health J 45:393-403, 2009 (AHRQ Publication No. 10-R006)* (Intramural).

• Blacks and whites spend about the same amount of time in office visits with psychiatrists. From 2001 to 2003, black patients had office-based visits with psychiatrists that were an average of 4.4 minutes shorter than visits by white patients (28.3 vs. 32.7 minutes). By 2004-2006, the time spent with a psychiatrist was about the same for black and white patients. Between these periods of time, there were longer visits by black patients rather than shorter visits by white patients, suggesting that the change was not mediated by treatment patterns.
  Source: Olfson, Cherry, and Lewis-Fernandez, Arch Gen Psychiatr 66(2):214-221, 2009 (AHRQ grant HS16097).

• Intervention may improve access to depression care for minority youths. These researchers studied the impact of a quality improvement intervention designed to improve access to evidence-based depression care for minority youths. Results showed a significant reduction in depression symptoms among blacks in the intervention group. Among Latinos, the only improvement was in care satisfaction, while there were no intervention effects for white youths.
  Source: Ngo, Asarnow, Lange, et al., Psychiatr Serv 60(10):1357-1364, 2009 (AHRQ grant HS09908).

• Asian Americans resist using mental health services. According to this study, Asian Americans may resist using Western mental health services for many reasons, including stigma, fear of institutionalization, and lack of faith in the benefits of psychotherapy. Those who do seek mental health care are among the most severely disturbed. This analysis of New York City data found that schizophrenic disorders were the most frequent diagnoses among Asians, with a rate twice as high for Asians as for other groups. They also stayed in the hospital longer than other patients: 2.59 additional days for Asians, compared with 1.67 additional days for other groups.
  Source: Shin, Issues Ment Health Nurs 30:112-121, 2009 (AHRQ grant HS00149).

• Blacks and Hispanics are less likely than whites to seek treatment for mental health problems. Researchers used 2001-2004 Medical Expenditure Panel Survey data to explore why minorities seek mental health services less frequently than whites. Just 7 percent of those surveyed reported fair or poor mental health, and whites were more likely than blacks to associate their mental symptoms with their mental health status. According to the authors, this finding suggests that the gap between whites, blacks, and Hispanics using mental health services likely reflects underuse by minorities and not overuse by whites.
  Source: Zuvekas and Fleishman, Medical Care 46(9):915-923, 2008 (AHRQ Publication No. 09-R007)* (Intramural).
• Racial disparities affect physician-patient communication about mental health problems. This study involved primary care visits made by 46 white and 62 black nonelderly adults with symptoms of depression who were seen by physicians in urban community-based practices. Communication about depression occurred in only about one-third of the visits (43 percent of white visits and 27 percent of black visits). Black patients were less likely than white patients to talk about their depression (11 vs. 38 statements, respectively). Also, physicians made fewer rapport-building statements during visits with black patients (21 statements) than during visits with white patients (30 statements). Even in visits where communication about depression occurred, physicians considered fewer black (67 percent) than white (93 percent) patients as suffering significant emotional distress.
  Source: Ghods, Roter, Ford, et al., J Gen Intern Med 23(5):600-606, 2008 (AHRQ grant HS13645).
• Certain types of therapy are more effective for minority youth with psychosocial problems. This review of the evidence found that psychotherapy is moderately effective for many mental health problems experienced by minority youth, although some treatments seem to work better than others. For example, multisystemic therapy is the only therapy shown to reduce criminal offending among black delinquent youths. It is delivered in the young person's home or school by specially trained therapists. Cognitive behavioral therapy and individual psychotherapy are preferable when treating depression in Latino adolescents. Ethnic minority youths seem to respond best to treatments that are highly structured, time-limited, pragmatic, and goal-oriented, note the researchers.
  Source: Huey and Polo, J Clin Child Adolesc Psychol 37(1):262-301, 2008 (AHRQ grant HS10870).
• Underserved blacks and Hispanics with depression often use alternative medicine for their symptoms. This study involved data on 315 patients with depression from two outpatient primary care clinics in Los Angeles; 66 percent of the patients were Hispanic, and 20 percent were black. Nearly 60 percent of the patients reported using complementary and alternative medicine (CAM) to manage their symptoms sometimes, and 24 percent used it often. Lack of health insurance was one of the strongest predictors of CAM use. These findings suggest that CAM use among underserved minority individuals may serve as a substitute for conventional care when access to care is limited or unavailable, note the researchers.
  Source: Bazargan, Ani, Hindman, et al., J Altern Complement Med 14(5):537-544, 2008. See also Bazargan, Norris, Bazargan-Hejazi, et al., Ethn Dis 15:531-539, 2005 (AHRQ grant HS14022).

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Preventive Services

• Study finds lower flu vaccination rates for black nursing home residents in same facilities. The average flu vaccination rate among nursing home residents nationwide was 72 percent during the 2005-2006 flu season, but the odds of being vaccinated were 14-16 percent lower for blacks than for whites within the same facility. Also, nursing homes with high proportions of black residents had lower vaccination rates for both black and white residents compared with homes that had a lower proportion of black residents. The researchers note that blacks are consistently more likely than whites to refuse flu vaccinations when offered; they also suggest that low revenue, insufficient staffing, and poor-quality care may contribute to the lower vaccination rates in these facilities.
  Source: Cai, Feng, Fennell, and Mor, Health Aff 30(10):1939-1946, 2011 (AHRQ grant HS16094).

• Culturally appropriate interventions raise flu and pneumonia vaccination rates at inner-city health centers. Researchers undertook a 4-year trial involving predominantly minority and economically disadvantaged patients older than age 50 using proven, culturally appropriate interventions at four inner-city health centers and compared the results with another center that received no intervention (the control). Over the 4-year trial, annual flu vaccination rates increased from 27 percent to 49 percent at the intervention sites, while the control site continued to have low rates of vaccination (20 percent). Intervention sites also increased use of pneumonia vaccinations, from 48 percent to 81 percent in patients aged 65 and older. Increases in vaccination rates were observed among white and Hispanic patients.
  Source: Nowalk, Zimmerman, Lin, et al., J Am Geriatr Soc 56(7):1177-1182, 2008 (AHRQ grant HS10864).