Gender and Race/Ethnicity Differences in Mental Health Care Use before and during the Great Recession

Article

Abstract

This study examines the changes in health care utilization for mental health disorders among patients who were diagnosed with depressive and/or anxiety disorders during the Great Recession 2007–2009 in the USA. Negative binomial regressions are used to estimate the association of the economic recession and mental health care use for females and males separately. Results show that prescription drug utilization (e.g., antidepressants, psychotropic medications) increased significantly during the economic recession 2007–2009 for both females and males. Physician visits for mental health disorders decreased during the same period. Results show that racial disparities in mental health care might have increased, while ethnic disparities persisted during the Great Recession. Future research should separately examine mental health care utilization by gender and race/ethnicity.

References

  1. 1.
    U.S. Bureau of Labor Statistics. The recession of 2007–2009. Available online at http://www.bls.gov/spotlight/2012/recession/pdf/recession_bls_spotlight.pdf. Accessed May 15, 2013.
  2. 2.
    Kochhar R, Fry R, Taylor P. Twenty-to-one: health gaps rise to record highs between whites, blacks and Hispanics. Pew Research Center, 2011. Available online at http://www.pewsocialtrends.org/files/2011/07/SDT-Wealth-Report_7-26-11_FINAL.pdf. Accessed May 15, 2013.
  3. 3.
    Goldman-Mellor S, Saxton K, Catalano R. Economic contraction and mental health: A review of the evidence, 1990–2009. Internal Journal of Mental Health 2010; 39(2): 6-31.CrossRefGoogle Scholar
  4. 4.
    Tausig M, Fenwick R. Recession and well-being. Journal of Health & Social Behavior 1999; 40: 1-16.CrossRefGoogle Scholar
  5. 5.
    Viinamaki H, Koskela K, Niskanen L. Rapidly declining mental wellbeing during unemployment. European Psychiatry 1996; 10: 215-221.Google Scholar
  6. 6.
    Catalano R. The health effects of economic insecurity. American Journal of Public Health 1991; 81(9): 1148-1152.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rugulies R, Thielen K, Nygaard E, et al. Job insecurity and the use of antidepressant medication among Danish employees with and without a history of prolonged unemployment: A 3.5-year follow-up study. Journal of Epidemiology & Community Health 2010; 64: 75–81.CrossRefGoogle Scholar
  8. 8.
    Catalano R. Health, medical care, and economic crisis. New England Journal of Medicine 2009; 360(8):749-51.CrossRefPubMedGoogle Scholar
  9. 9.
    Catalano R, Goldman-Mellor S, Saxton K, et al. The health effects of economic decline. Annual Review of Public Health 2011; 32: 431-50.CrossRefPubMedGoogle Scholar
  10. 10.
    Levit KR, Mark TL, Coffey RM, et al. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance. Health Affairs 2013; 32: 952–962.CrossRefPubMedGoogle Scholar
  11. 11.
    Bertakis K, Azari R, Helms L, et al. Gender differences in the utilization of health care services. Journal of Family Practice 2000; 49(2): 147-152.PubMedGoogle Scholar
  12. 12.
    Owens, GM. Gender differences in health care expenditures, resource utilization, and quality of care. Journal of Managed Care Pharmacy 2008; 14(3) (Suppl S): S2-S6.Google Scholar
  13. 13.
    Olfson M, Marcus SC, Druss B, et al. National trends in the outpatient treatment of depression. The Journal of American Medical Association 2002; 287(2):203–209.CrossRefGoogle Scholar
  14. 14.
    Kessler RC, Zhao S, Katz SJ, et al. Past year use of outpatient services for psychiatric problems in the National Comorbidity Survey. American Journal of Psychiatry 1999; 156: 115- 123.CrossRefPubMedGoogle Scholar
  15. 15.
    Regier DA, Narrow WE, Rae DS, et al. The de facto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 1993; 50(2):85–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Williams JB, Spitzer RL, Linzer M, et al. Gender differences in depression in primary care. American Journal of Obstetrics & Gynecology 1995; 173: 654- 659.CrossRefGoogle Scholar
  17. 17.
    Kessler RC, Brown RL, Broman CL. Sex differences in psychiatric help-seeking: evidence from four large-scale surveys. Journal of Health and Social Behavior 1981; 22: 49- 64.CrossRefPubMedGoogle Scholar
  18. 18.
    Taylor P, Fry R, Cohn D, et al. Women, men and the new economics of marriage. Pew Research Center. 2010.Google Scholar
  19. 19.
    Harman JS, Edlund MJ, Fortney JC. Disparities in the adequacy of depression treatment in the United States. Psychiatric Services 2004; 55:1379–1385.CrossRefPubMedGoogle Scholar
  20. 20.
    Harris K, Edlund M, Larson S. Racial and ethnic differences in mental health problems and use of mental health care. Medical Care 2005; 43:775–784.CrossRefPubMedGoogle Scholar
  21. 21.
    Riva M, Bambra C, Easton S, et al. Hard times or good times? Inequalities in the health effects of economic change. International Journal of Public Health 2011; 56: 3–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Trevino FM, Moyer ME, Valdez RB, et al. Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans. The Journal of American Medical Association 1991; 265(2): 233-237.CrossRefGoogle Scholar
  23. 23.
    Blendon R, Aiken L, Freeman H, et al. Access to medical care for black and white Americans. The Journal of American Medical Association 1989; 261(2): 278-281.CrossRefGoogle Scholar
  24. 24.
    U.S. Bureau of Labor Statistics. The Recession of 2007-2009. 2012. Available online at http://www.bls.gov/spotlight/2012/recession/pdf/recession_bls_spotlight.pdf. Accessed May 15, 2013.
  25. 25.
    The Commonwealth Fund. Realizing health reform’s potential: When unemployed means uninsured: the toll of job loss on health coverage, and how the Affordable Care Act will help. 2011. Available online at http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Aug/1540_Doty_when_unemployed_means_uninsured_COBRA_reform%20brief.pdf. Accessed May 15, 2013.
  26. 26.
    Holahan J. The 2007–09 recession and health insurance coverage. Health Affairs 2011; 30(1):145–152.CrossRefPubMedGoogle Scholar
  27. 27.
    US Department of Health, Human Services. Mental health: A report of the surgeon general—executive summary. Rockville: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.1999.Google Scholar
  28. 28.
    Jonghe F, Hendricksen M, Dekker J. Psychotherapy alone and combined with pharmacotherapy in the treatment of depression. Br J Psychiatry. 2004; 185: 37–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Norcross, C., Goldfried, M. Handbook of psychotherapy integration (clinical psychology). 2nd ed. New York, NY: Oxford University Press, 2005.CrossRefGoogle Scholar
  30. 30.
    Lecrubier Y. The burden of depression and anxiety in general medicine. Journal of Clinical Psychiatry 2001; 62 (Suppl 8): 4-9.PubMedGoogle Scholar
  31. 31.
    Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics 2007; 25: 7-24.CrossRefPubMedGoogle Scholar
  32. 32.
    Wang PS, Aguilar-Gaxiola S, Alonso J, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 2007; 370: 841–850.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Cohen JW, Cohen SB, Banthin JS. The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice. Medical Care 2009; 47(7 Suppl 1):S44–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Hall R, Feldstein M, Bernanke B, et al. The business-cycle peak of March 2001. National Bureau of Economic Research. Available online at http://www.nber.org/cycles/november2001/ Accessed Dec 14, 2013.
  35. 35.
    Cook BL, McGuire T, Miranda J. Measuring trends in mental health care disparities, 2000 2004. Psychiatric Services 2007; 58(12): 1533-1540.CrossRefPubMedGoogle Scholar
  36. 36.
    Chen J, Rizzo J. Racial and ethnic disparities in psychotherapy services—evidence from U.S. national survey data. Psychiatric Services 2010; 61:364-372.Google Scholar
  37. 37.
    Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care 1996; 34:220.CrossRefPubMedGoogle Scholar
  38. 38.
    Salyers MP, Bosworth HB, Swanson JW, et al. Reliability and validity of the SF-12 health survey among people with severe mental illness. Medical Care 2000; 38:1141-1150.CrossRefPubMedGoogle Scholar
  39. 39.
    Cheak-Zamora NC, Wyrwich KW, McBride TD. Reliability and validity of the SF-12v2 in the medical expenditure panel survey. Quality of Life Research 2009; 18, 727-735.CrossRefPubMedGoogle Scholar
  40. 40.
    Centers for Disease Control and Prevention. Non-specific Psychological Distress. 2013. Available online at http://www.cdc.gov/mentalhealth/data_stats/nspd.htm. Accessed May 15, 2013.
  41. 41.
    Jones A. Health econometrics. In: Culyer AJ, Newhouse JP (Eds). Handbook of Health Economics. Amsterdam: Elsevier; 2000.Google Scholar
  42. 42.
    Zarkin GA, Bray JW, Babor TF, et al. Alcohol drinking patterns and health care utilization in a managed care organization. Health Services Research 2004; 39(3):553–570.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Center on Budget and Policy Priorities. Expanding Medicaid will benefit both low-income women and their babies. 2013. Available online at http://www.cbpp.org/files/Fact-Sheet-Impact-on-Women.pdf. Accessed Dec. 14, 2013
  44. 44.
    Kaiser Family Foundation. Medicaid medically needy enrollees by eligibility category. Available online at http://kff.org/medicaid/state-indicator/enrollment-by-eligibility-category/ Accessed Dec. 14, 2013
  45. 45.
    Chen J, Vargas-Bustamante A, Mortensen K, et al. Using quantile regression to examine health care expenditures during the Great Recession. Health Services Research 2013. doi: 10.1111/1475-6773.12113. [Epub ahead of print]
  46. 46.
    SAMHSA. Mental Health Parity and Addiction Equity Act. Available online at http://www.samhsa.gov/healthreform/parity/. Accessed May 15, 2013.
  47. 47.
    SAMHSA-HRSA Center for Integrated health solutions. Integrated care models. Available online at http://www.integration.samhsa.gov/integrated-care-models. Accessed May 15, 2013.
  48. 48.
    Agency Healthcare Research and Quality. Integration of mental health/substance abuse and primary care. Available online at http://www.ahrq.gov/research/findings/evidence-based-reports/mhsapc-evidence-report.pdf. Accessed May 15, 2013.

Copyright information

© National Council for Behavioral Health 2014

Authors and Affiliations

  1. 1.Department of Health Services Administration, School of Public HealthUniversity of MarylandCollege ParkUSA
  2. 2.Department of Health Services Administration, School of Public HealthUniversity of MarylandCollege ParkUSA

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