Referral sources, diagnoses, and service types of youth in public outpatient mental health care: A focus on ethnic minorities

  • May Yeh
  • Kristen McCabe
  • Michael Hurlburt
  • Richard Hough
  • Andrea Hazen
  • Shirley Culver
  • Ann Garland
  • John Landsverk
Regular Articles


Racial/ethnic variations in clinical and service delivery characteristics among youth in public outpatient mental health services were examined using data from San Diego County mental health service programs for fiscal year 1996 to 1997 (N=3,962). Differences in referral sources, primary diagnoses, and service types were investigated for three racial/ethnic groups (African Americans, Asian/Pacific Islander Americans, and Latinos) compared to non-Hispanic whites. Controlling for age, gender, functional impairment, and prior service use, significant differences by race/ethnicity were found for all three variables studied. Possible explanations for these variations and future directions for research are discussed.


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  1. 1.
    American Public Health Association. Proposed policy statements to be considered at annual meeting.The Nation's Health. September, 2000; 23–24.Google Scholar
  2. 2.
    Department of Health and Human Services.Healthy People 2010: Goals (2000). Accessed December 20, 2000.Google Scholar
  3. 3.
    National Institute of Mental Health.Strategic Plan for Reducing Health Disparities (2000). Accessed December 20, 2000.Google Scholar
  4. 4.
    Hohmann A. A contextual model for clinical mental health effectiveness research.Mental Health Services Research. 1999;1:83–91.Google Scholar
  5. 5.
    Takeuchi DT, Bui KV, Kim L. The referral of minority adolescents to community mental health centers.Journal of Health and Social Behavior. 1993;34:153–164.Google Scholar
  6. 6.
    Costello EJ, Pescosolido BA, Angold A, et al. A family network-based model of access to child mental health services.Research in Community Mental Health. 1998;9:165–190.Google Scholar
  7. 7.
    Pescosolido BA, Brooks-Gardner C, Lubell K. How people get into mental health services: stories of choice, coercion, and “muddling through” from “first-timers.”Social Science and Medicine. 1998;46:275–286.Google Scholar
  8. 8.
    Garland AF, Besinger BA. Racial/ethnic differences in court referred pathways to mental health services for children in foster care.Children and Youth Services Review. 1997;19:651–666.Google Scholar
  9. 9.
    Gunter-Justice TD, Ott DA. Who does the family court refer for psychiatric services?Journal of Forensic Science. 1997;42:1102–1104.Google Scholar
  10. 10.
    Hu TW, Snowden LR, Jerrell JM, et al. Ethnic populations in public mental health: services choice and level of use.American Journal of Public Health. 1991;81:1429–1434.Google Scholar
  11. 11.
    Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States.Archives of General Psychiatry. 1994;51:8–19.Google Scholar
  12. 12.
    Costello EJ, Angold A, Burns BJ, et al. The Great Smoky Mountains study of youth: goals, design, methods, and the prevalence of DSM-III-R disorders.Archives of General Psychiatry. 1996;53:1129–1136.Google Scholar
  13. 13.
    Lopez S. Patient variable biases in clinical judgment: conceptual overview and methodological considerations.Psychological Bulletin. 1989;106:184–203.Google Scholar
  14. 14.
    Westermeyer J. Cultural factors in clinical assessment.Journal of Consulting and Clinical Psychology. 1987;55:471–478.Google Scholar
  15. 15.
    Adebimpe VR, Hedlund JL, Cho DW, et al. Symptomatology of depression in black and white patients.Journal of the National Medical Association. 1982;74:185–190.Google Scholar
  16. 16.
    Bui K, Takeuchi DT. Ethnic minority adolescents and the use of community mental health care services.American Journal of Community Psychology. 1992;20:403–417.Google Scholar
  17. 17.
    McCabe KM, Yeh M, Hough RL, et al. Racial/ethnic variation across five public systems of care for youth.Journal of Emotional and Behavioral Disorders. 1999;7:72–82.Google Scholar
  18. 18.
    Cheung FK, Snowden LR. Community mental health and ethnic minority populations.Community Mental Health Journal. 1990;26:277–291.Google Scholar
  19. 19.
    Snowden LR, Cheung FK. Use of inpatient mental health services by members of ethnic minority groups.American Psychologist. 1990;45:347–355.Google Scholar
  20. 20.
    SANDAG.San Diego Association of Governments: Population Estimates by Age, Sex, and Ethnic Group 1995.Google Scholar
  21. 21.
    Dougherty Management Associates.Children's Mental Health Benchmarking Project: First Year Report. Lexington, MA: Author; 2000.Google Scholar
  22. 22.
    American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  23. 23.
    Pope CE, Feyerherm WF.Minorities and the Juvenile Justice System. Washington, DC: US Dept of Justice; 1995. OJJDP publication NCJ 145849.Google Scholar
  24. 24.
    Kessler RC, Zhao S, Blazer DG, et al. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Study.Journal of Affective Disorders. 1997;45:19–30.Google Scholar
  25. 25.
    Neighbors HW. Seeking professional help for personal problems: black Americans' use of health and mental health services.Community Mental Health Journal. 1985;21:156–166.Google Scholar
  26. 26.
    Uba L.Asian Americans: Personality Patterns, Identity, and Mental Health. New York: The Guilford Press; 1994.Google Scholar
  27. 27.
    Kinzie JD, Tseng W. Cultural aspects of psychiatric clinic utilization: a cross-cultural study in Hawaii.International Journal of Social Psychiatry. 1978;24:177–188.Google Scholar
  28. 28.
    Sue S. Mental health. In: Zane NWS, Takeuchi DT, Young KNJ, eds.Confronting Critical Health Issues of Asian and Pacific Islander Americans. Thousand Oaks, CA: Sage Publications; 1994:266–288.Google Scholar
  29. 29.
    Yeh M, Takeuchi DT, Sue S. Asian-American children treated in the mental health system: a comparison of parallel and mainstream outpatient service centers.Journal of Clinical Child Psychology. 1994;23:5–12.Google Scholar
  30. 30.
    Vega WA, Kolody B, Aguilar-Gaxiola S, et al. Gaps in service utilization by Mexican Americans with mental health problems.American Journal of Psychiatry. 1999;156:928–934.Google Scholar
  31. 31.
    Glover SH, Pumariega AJ, Holzer CE, et al. Anxiety symptomatology in Mexican-American adolescents.Journal of Child and Family Studies. 1999;8:47–57.Google Scholar
  32. 32.
    Warheit GJ, Vega WA, Auth JB, et al. Psychiatric symptoms and dysfunction among Anglos and Mexican Americans: an epidemiologic study.Research in Community and Mental Health. 1985;5:3–32.Google Scholar
  33. 33.
    Greenblatt M, Norman M. Hispanic mental health and use of mental health services: a critical review of the literature.American Journal of Social Psychiatry. 1982;3:25–31.Google Scholar
  34. 34.
    Bird HR. Epidemiology of childhood disorders in a cross-cultural context.Journal of Child Psychology and Psychiatry. 1996;37:35–49.Google Scholar
  35. 35.
    Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children version 2.3 (DISC 2.3): Description, acceptability, prevalence rates, and performance in the MECA study.Journal of the American Academy of Child and Adolescent Psychiatry. 1996;35:865–877.Google Scholar
  36. 36.
    Scheffler RM, Browne-Miller A. Demand analysis of mental health service use among ethnic subpopulations.Inquiry. 1989;26:202–215.Google Scholar
  37. 37.
    Akutsu PD, Snowden LR, Organista KC. Referral patterns in ethnic-specific and mainstream programs for ethnic minorities and whites.Journal of Counseling Psychology. 1996;43:56–64.Google Scholar
  38. 38.
    Weisz JR, Suwanlert S, Chaiyasit W, et al. Adult attitudes toward over- and undercontrolled child problems: urban and rural parents and teachers from Thailand and the United States.Journal of Child Psychology and Psychiatry. 1991;32:645–654.Google Scholar
  39. 39.
    Weisz JR, Suwanlert S, Chaiyasit W, et al. Thai and American perspectives on over- and undercontrolled child behavior problems: exploring the threshold model among parents, teachers, and psychologists.Journal of Consulting and Clinical Psychology. 1988;56:601–609.Google Scholar
  40. 40.
    Costello EJ. Child psychiatric epidemiology: implications for clinical research and practice. In: Lahey BB, Kazdin AE, eds.Advances in Clinical Child Psychology. New York: Plenum Press; 1990;13:53–90.Google Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2002

Authors and Affiliations

  • May Yeh
    • 1
    • 2
  • Kristen McCabe
    • 2
    • 3
  • Michael Hurlburt
    • 2
  • Richard Hough
    • 1
    • 2
    • 3
  • Andrea Hazen
    • 2
  • Shirley Culver
    • 2
  • Ann Garland
    • 1
    • 2
  • John Landsverk
    • 2
    • 3
  1. 1.University of CaliforniaSan Diego
  2. 2.Child and Adolescent Services Research CenterChildren's Hospital and Health Center San DiegoSan Diego
  3. 3.University of San DiegoUSA

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