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Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study

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Abstract

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

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Funding

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health under Award Number R01MD009719. Dr Jackson is supported by the NIMHD Center for Integrative Approaches to Health Disparities (P60-MD002249). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Wheelock College of Education & Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, USA

    Jennifer Greif Green

  2. Department of Psychology, Harvard University, Cambridge, MA, USA

    Katie A. McLaughlin

  3. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Mirko Fillbrunn, Marie Fukuda, Corrie Vilsaint, Mario Cruz-Gonzalez & Margarita Alegría

  4. Department of Psychology, University of Michigan, Ann Arbor, MI, USA

    James S. Jackson

  5. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Ronald C. Kessler, Ekaterina Sadikova & Nancy A. Sampson

  6. Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA

    David R. Williams

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  1. Jennifer Greif Green
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  2. Katie A. McLaughlin
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Correspondence to Jennifer Greif Green.

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Conflict of interest

In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The other authors declare no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Appendix

Appendix

Barriers to use and reasons for dropout treatment: CPES surveys.

Barriers to use

Reasons for dropout

Low perceived need

Low perceived need

The problem went away by itself, and I did not really need help

You didn’t need help anymore

Structural barriers

Structural barriers

My health insurance would not cover this type of treatment

The therapist or counselor left or moved away

I was concerned about how much money it would cost

The policies were a hassle

I was unsure about where to go or who to see

There were problems with lack of time, schedule change, or lack of transportation

I thought it would take too much time or be inconvenient

You moved

I could not get an appointment

Treatment was too expensive

I had problems with things like transportation, childcare, or scheduling that would have made it hard to get treatment

Your health insurance would not pay for more treatment

Attitudinal barriers

Attitudinal barriers

I thought the problem would get better by itself

You got better

I didn’t think treatment would work

You were not getting better

I was concerned about what others might think if they found out I was in treatment

You wanted to handle the problem on your own

I wanted to handle the problem on my own

You had bad experiences with the treatment providers

I was scared about being put in the hospital against my will

You were concerned about what people would think if they found out you were in treatment

I was not satisfied with available services

You were treated badly or unfairly

I received treatment before and it did not work

You felt out of place

The problem didn’t bother me very much

Your family wanted you to stop

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Green, J.G., McLaughlin, K.A., Fillbrunn, M. et al. Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study. Adm Policy Ment Health 47, 606–616 (2020). https://doi.org/10.1007/s10488-020-01021-6

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