Mental health care preferences among low-income and minority women

  • Erum NadeemEmail author
  • Jane M. Lange
  • Jeanne Miranda
Original contribution


Mental health care preferences are examined among 1,893 low-income immigrant and U.S.-born women with an acknowledged emotional problem (mean age = 29.1, SD = 89.6). Ethnicity, depression, somatization, and stigma are examined as they relate to mental health care preferences (medication, individual and group counseling, faith, family/friends). Seventy-eight percent of participants counseling would be helpful; 55%; group counseling; and 32% medication. Faith was cited by 81%; family and friends were endorsed by 65%. Minorities had lower odds than Whites of endorsing medication (Black immigrants: OR = 0.27, p < 0.001, U.S.-born Blacks: OR = 0.30, p < 0.001, immigrant Latinas: OR = 0.50, p < 0.01). Most minorities also had higher odds of endorsing faith compared to Whites (Black immigrants: OR = 3.62, p < 0.001; U.S.-born Blacks, OR = 3.85, p < 0.001; immigrant Latinas: OR = 9.76, p < 0.001). Being depressed was positively associated with endorsing medication (OR = 1.93, p < 0.001), individual counseling (OR = 2.66, p < 0.001), and group counseling (OR = 1.35, p < 0.01). Somatization was positively associated with endorsing medication (OR = 1.29, p < 0.05) and faith (OR = 1.37, p < 0.05). Stigma-concerns reduced the odds of endorsing group counseling (OR = 0.58, p < 0.001). Finally, being in mental health treatment was related to increased odds of endorsing medication (OR = 3.88, p < 0.001) and individual counseling (OR = 2.29, p = 0.001).


Minority women Depression Treatment preferences Stigma 



This research was funded by National Institute of Mental Health Grants MHR01070260 and MH56864. Writing of this article was funded through three centers: Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) funded by National Institute of Health/National Institute on Aging (3P03AG021684), UCLA/Drew Project EXPORT funded by the National Institute of Health/National Center for Minority Health and Health Disparities (1P20MD00148-01), and UCLA-RAND Center for Research on Quality in Managed Care (MH068639-01) and the John D. and Catherine T. MacArthur Foundation.


  1. Adewuya AO, Makanjuola RO (2005) Social distance towards people with mental illness amongst Nigerian university students. Soc Psychiatry Psychiatr Epidemiol 40:865–868PubMedCrossRefGoogle Scholar
  2. Alvidrez J (1999) Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women. Community Ment Health J 35:515–530PubMedCrossRefGoogle Scholar
  3. Alvidrez J, Azocar F (1999) Distressed women’s clinic patients: preferences for mental health treatments and perceived obstacles. Gen Hosp Psych 21:340–347CrossRefGoogle Scholar
  4. Arean PA, Miranda J (1996) Do primary care patients accept psychological treatments? Gen Hosp Psych 18:22–27CrossRefGoogle Scholar
  5. Cooper LA, Gonzales JJ, Gallo JJ, Rost KM, Meredith LS, Rubenstein LV, Wang NY, Ford DE (2003) The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Med Care 41:479–489PubMedCrossRefGoogle Scholar
  6. Cooper-Patrick L, Powe NR, Jenckes MW, Gonzales JJ, Levine DM, Ford DE (1997) Identification of patient attitudes and preferences regarding treatment of depression. J Gen Intern Med 12:431–438PubMedCrossRefGoogle Scholar
  7. Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB (2000) Treatment preferences among depressed primary care patients. J Gen Intern Med 15:527–534PubMedCrossRefGoogle Scholar
  8. Edge D, Rogers A (2005) Dealing with it: Black Caribbean women’s response to adversity and psychological distress associated with pregnancy, childbirth, and early motherhood. Soc Sci Med 61:15–25PubMedCrossRefGoogle Scholar
  9. Edge D, Baker D, Rogers A (2004) Perinatal depression among black Caribbean women. Health Soc Care Community 12:430–438PubMedCrossRefGoogle Scholar
  10. Escobar JI, Golding JM, Hough RL, Karno M, Burnam MA, Wells KB (1987) Somatization in the community: relationship to disability and use of services. Am J Public Health 77:837–840PubMedGoogle Scholar
  11. Halbert CH, Armstrong K, Gandy OH Jr, Shaker L (2006) Racial differences in trust in health care providers. Arch Intern Med 166:896–901PubMedCrossRefGoogle Scholar
  12. Hutchinson G, Gilvarry C (1998) Ethnicity and dissatisfaction with mental health services. Br J Psychiatry 172:95–96PubMedCrossRefGoogle Scholar
  13. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105PubMedCrossRefGoogle Scholar
  14. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005a) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602CrossRefGoogle Scholar
  15. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005b) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627CrossRefGoogle Scholar
  16. Kirmayer LJ, Young A (1998) Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosom Med 60:420–430PubMedGoogle Scholar
  17. Lowe B, Schulz U, Grafe K, Wilke S (2006) Medical patients’ attitudes toward emotional problems and their treatment. What do they really want? J Gen Intern Med 21:39–45PubMedCrossRefGoogle Scholar
  18. Makanjuola JD, Olaifa EA (1987) Masked depression in Nigerians treated at the Neuro-Psychiatric Hospital Aro, Abeokuta. Acta Psychiatr Scand 76:480–485PubMedCrossRefGoogle Scholar
  19. Miranda J, Chung JY, Green BL, Krupnick J, Siddique J, Revicki DA, Belin T (2003) Treating depression in predominantly low-income young minority women: a randomized controlled trial. JAMA 290:57–65PubMedCrossRefGoogle Scholar
  20. Miranda J, Green BL, Krupnick JL, Chung J, Siddique J, Belin T, Revicki D (2006) One-year outcomes of a randomized clinical trial treating depression in low-income minority women. J Consult Clin Psychol 74:99–111PubMedCrossRefGoogle Scholar
  21. Nadeem E, Lange JM, Edge D, Fongwa M, Belin T, Miranda J (2007) Does stigma keep poor young immigrant and U.S.-Born black and Latina women from seeking mental health care? Psychiatr Serv 58:1547–1554PubMedCrossRefGoogle Scholar
  22. Otote DI, Ohaeri JU (2000) Depressive symptomatology and short-term stability at a Nigerian psychiatric care facility. Psychopathology 33:314–323PubMedCrossRefGoogle Scholar
  23. Sabogal F, Marin G, Otero-Sabogal R, Marin BV et al (1987) Hispanic familism and acculturation: what changes and what doesn’t? Hisp J Behav Sci 9:397–412CrossRefGoogle Scholar
  24. Schreiber R, Stern PN, Wilson C (2000) Being strong: how black West-Indian Canadian women manage depression and its stigma. J Nurs Scholarsh 32:39–45PubMedCrossRefGoogle Scholar
  25. Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV 3rd, Hahn SR, Brody D, Johnson JG (1994) Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 272:1749–1756PubMedCrossRefGoogle Scholar
  26. Sussman LK, Robins LN, Earls F (1987) Treatment-seeking for depression by black and white Americans. Soc Sci Med 24:187–196PubMedCrossRefGoogle Scholar
  27. U.S. Census Bureau (2001) Population profile of the United States: 1999. U.S. Government Printing Office, Washington, DCGoogle Scholar
  28. U.S. Public Health Service (2001) Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the surgeon general. Department of Health and Human Services, Rockville, MDGoogle Scholar
  29. van Schaik DJ, Klijn AF, van Hout HP, van Marwijk HW, Beekman AT, de Haan M, van Dyck R (2004) Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psych 26:184–189CrossRefGoogle Scholar
  30. Vega WA, Kolody B, Aguilar-Gaxiola S, Catalano R (1999) Gaps in service utilization by Mexican Americans with mental health problems. Am J Psychiatry 156:928–934PubMedGoogle Scholar
  31. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:629–640PubMedCrossRefGoogle Scholar
  32. Williams JW Jr, Barrett J, Oxman T, Frank E, Katon W, Sullivan M, Cornell J, Sengupta A (2000) Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. JAMA 284:1519–1526PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Erum Nadeem
    • 1
    • 2
    • 3
    Email author
  • Jane M. Lange
    • 4
  • Jeanne Miranda
    • 2
    • 3
  1. 1.Department of Health Services, School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Health Services Research CenterUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesUSA
  4. 4.Department of BiostatisticsUniversity of WashingtonSeattleUSA

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