Ethnic Identity, Acculturation, and 12-Month Psychiatric Service Utilization Among Black and Hispanic Adults in the U.S.

  • Inger Burnett-Zeigler
  • Yuri Lee
  • Kipling M. Bohnert


A cross-sectional study design was used to examine the associations of ethnic identity, acculturation, and psychiatric service utilization among Wave 2 respondents of the National Epidemiologic Survey on Alcohol Related Conditions with 12-month psychiatric disorders who self-identified as Black (6587, 19%) and Hispanic (6359, 18%). Weighted multivariable regression analyses were conducted to examine the relationships between ethnic identity, acculturation, and 12-month psychiatric service utilization. Stronger ethnic identity was associated with decreased odds of using psychiatric services among Black (AOR = 0.956; CI = 0.923–0.991) and Hispanic individuals (AOR = 0.967; CI = 0.945–0.990). Greater acculturation was associated with an increased odds of psychiatric service utilization for Hispanic individuals (AOR = 1.025; CI = 1.000–1.050). These findings suggest that a sense of pride, belonging, and attachment to one’s racial/ethnic group and participating in ethnic behaviors is associated with lower rates of participation in psychiatric services; alternatively, acquiring key elements of the U.S. culture is associated with greater participation in psychiatric services.


Ethnic identity Acculturation Race/ethnicity Psychiatry Service utilization 


  1. 1.
    Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Study. Archives of General Psychiatry. 1994;51(1):8–19.CrossRefPubMedGoogle Scholar
  2. 2.
    Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine. 2005;352(24):2515–2523.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    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(1):115–123.CrossRefPubMedGoogle Scholar
  4. 4.
    Regier DA, Narrow WE, Rae DS, et al. The de Facto US Mental and Addictive Disorders Service System. Archives of General Psychiatry. 1993;50:85–94.CrossRefPubMedGoogle Scholar
  5. 5.
    Gwynn RC, McQuistion HL, McVeigh KH, et al. Prevalence, diagnosis, and treatment of depression and generalized anxiety disorder in a diverse urban community. Psychiatric Services. 2008;59(6):641–647.CrossRefPubMedGoogle Scholar
  6. 6.
    Holahan CJ, Pahl SA, Cronkite RC, et al. Depression and vulnerability to incident physical illness across 10 years. Journal of Affective Disorders. 2010;123(1–3):222–229.CrossRefPubMedGoogle Scholar
  7. 7.
    Miller BJ, Paschall CB, III, Svendsen DP. Mortality and medical comorbidity among patients with serious mental illness. Psychiatric Services. 2006;57(10):1482–1487.CrossRefPubMedGoogle Scholar
  8. 8.
    Penninx BWJH, Beekman ATF, Honig A, et al. Depression and cardiac mortality: results from a community-based longitudinal study. Archives of General Psychiatry. 2001;58(3):221–227.CrossRefPubMedGoogle Scholar
  9. 9.
    Whooley MA, Kiefe CI, Chesney MA, et al. Depressive symptoms, unemployment, and loss of income. Archives of Internal Medicine. 2002;162:2614–2620.CrossRefPubMedGoogle Scholar
  10. 10.
    Young AS, Klap R, Shoai R, et al. Persistent depression and anxiety in the united states: prevalence and quality of care. Psychiatric Services. 2008;59(12):1391–1398.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA: Journal of the American Medical Association. 2003;289(23):3095–3105.CrossRefPubMedGoogle Scholar
  12. 12.
    Hasin DS, Goodwin RD, Stinson FS, et al. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Archives of General Psychiatry. 2005;62(10):1097–1106.CrossRefPubMedGoogle Scholar
  13. 13.
    Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):617–627.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cannon M, Locke B. Being black is detrimental to one’s mental health: myth or reality? Phylon. 1977;38:408–428.CrossRefGoogle Scholar
  15. 15.
    Kramer M, Rosen B, Willis E. Definitions and distributions of mental disorders in a racist society. In: Willie C, Kramer M, Brown B, eds. Racism and mental health. Pittsburgh: University of Pittsburgh Press; 1973.Google Scholar
  16. 16.
    Kleiner RJ, Tuckman J, Lavell M. Mental disorder and status based on race. Psychiatry: Journal for the Study of Interpersonal Processes. 1960;23:271–274.CrossRefGoogle Scholar
  17. 17.
    Fischer J. Negroes and whites and rates of mental illness: reconsideration of a myth. Psychiatry: Journal for the Study of Interpersonal Processes. 1969;32(4):428–446.CrossRefGoogle Scholar
  18. 18.
    Mirowsky J, Ross C. Minority status, ethnic culture, and distress: a comparison of blacks, whites, Mexicans, and Mexican-Americans. American Journal of Sociology. 1980;86(3):479–495.CrossRefGoogle Scholar
  19. 19.
    Breslau J, Aguilar-Gaxiola S, Kendler KS, et al. Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences. 2006;36(1):57–68.CrossRefGoogle Scholar
  20. 20.
    Smith SM, Stinson FS, Dawson DA, et al. Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences. 2006;36(7):987–998.CrossRefGoogle Scholar
  21. 21.
    Wang PS, Lane M, Olfson M, et al. Twelve-month use of mental health services in the United States. Archives of General Psychiatry. 2005;62:629–640.CrossRefPubMedGoogle Scholar
  22. 22.
    Marcus SC, Olfson M. National trends in the treatment for depression from 1998 to 2007. Archives of General Psychiatry. 2010;67(12):1265–1273.CrossRefPubMedGoogle Scholar
  23. 23.
    Olfson M, Marcus SC, Druss B, et al. National trends in the outpatient treatment of depression. Journal of the American Medical Association. 2002;287(2):203–209.CrossRefPubMedGoogle Scholar
  24. 24.
    Neighbors HW, Caldwell C, Williams DR, et al. Race, ethnicity, and the use of services for mental disorders: results from the National Survey of American Life. Archives of General Psychiatry. 2007;64(4):485–494.CrossRefPubMedGoogle Scholar
  25. 25.
    Alegría M, Chatterji P, Wells K, et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services. 2008;59(11):1264–1272.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    van Beljouw I, Verhaak P, Prins M, et al. Reasons and determinants for not receiving treatment for common mental disorders. Psychiatric Services. 2010;61(3):250–257.CrossRefPubMedGoogle Scholar
  27. 27.
    Mojabai R, Olfson M, Mechanic D. Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry. 2002;59:78–84.Google Scholar
  28. 28.
    Berglund PA, Bruce ML, Kessler RC, et al. The prevalence and correlates of untreated serious mental illness. (Articles). Health Services Research. 362001:987+.Google Scholar
  29. 29.
    Ojeda VD, Bergstresser SM. Gender, race-ethnicity, and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need. Journal of Health and Social Behavior. 2008;49(3):317–334.CrossRefPubMedGoogle Scholar
  30. 30.
    Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10.Google Scholar
  31. 31.
    Gonzalez JM, Alegría M, Prihoda TJ, et al. How the relationship of attitudes toward mental health treatment and service use differs by age, gender, ethnicity/race and education. Social Psychiatry and Psychiatric Epidemiology. 2011;46(1):45–57.CrossRefPubMedGoogle Scholar
  32. 32.
    Menke R, Flynn H. Relationships between stigma, depression, and treatment in White and African American primary care patients. Journal of Nervous and Mental Disease. 2009;197(6):407–411.CrossRefPubMedGoogle Scholar
  33. 33.
    Conner KO, Copeland VC, Grote NK, et al. Mental health treatment seeking among older adults with depression: the impact of stigma and race. The American Journal of Geriatric Psychiatry. 2010;18(6):531–543.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rusch LC, Kanter JW, Manos RC, et al. Depression stigma in a predominantly low income African American sample with elevated depressive symptoms. Journal of Nervous and Mental Disease. 2008;196(12):919–922.PubMedGoogle Scholar
  35. 35.
    Brandon DT, Isaac LA, Laveist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? Journal of the National Medical Association. 2005;97(7):951.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Tucker JR, Hammer JH, Vogel DL, et al. Disentangling self-stigma: are mental illness and help-seeking self-stigmas different? J Couns Psychol. 2013;60(4):520–531.CrossRefPubMedGoogle Scholar
  37. 37.
    Lin LN, A. Christidis, P. and Stamm, K. 2005–13 Demographics of the U.S. Psychology Workforce. American Psychological Association Center for Workforce Studies, Washington D.C, 2015.Google Scholar
  38. 38.
    Santiago CD, Miranda J. Progress in improving mental health services for racial-ethnic minority groups: a ten-year perspective. Psychiatric Services 2014;65(2):180–185.CrossRefPubMedGoogle Scholar
  39. 39.
    Lagomasino IT, Stockdale SE, Miranda J. Racial-ethnic composition of provider practices and disparities in treatment of depression and anxiety, 2003–2007. Psychiatric Services. 2011;62(9):1019–1025.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    van Schaik DJF, Klijn AFJ, van Hout HPJ, et al. Patients’ preferences in the treatment of depressive disorder in primary care. General Hospital Psychiatry. 2004;26(3):184–189.CrossRefPubMedGoogle Scholar
  41. 41.
    Cooper LA, Gonzales JJ, Gallo JJ, et al. The acceptability of treatment for depression among African-American, Hispanic, and White primary care patients. Medical Care. 2003;41(4):479–489.PubMedGoogle Scholar
  42. 42.
    Kasckow J, Ingram E, Brown C, et al. Differences in treatment attitudes between depressed African-American and Caucasian veterans in primary care. Psychiatric Services. 2011;62(4):426–429.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Givens JL, Houston TK, Van Voorhees BW, et al. Ethnicity and preferences for depression treatment. General Hospital Psychiatry. 2007;29(3):182–191.CrossRefPubMedGoogle Scholar
  44. 44.
    Burlew AK. Ethnic and racial identity: racial identity. In: Kazdin AE, ed. Encyclopedia of Psychology, 3. Washington DC, American Psychological Association 2000:259–263.Google Scholar
  45. 45.
    Phinney JS. Stages of ethnic identity development in minority group adolescents. The Journal of Early Adolescence. 1989;9(1–2):34–49.CrossRefGoogle Scholar
  46. 46.
    Phinney JS. Understanding ethnic diversity: the role of ethnic identity. American Behavioral Scientist. 1996;40(2):143–152.CrossRefGoogle Scholar
  47. 47.
    Phinney JS. Ethnic identity and self-esteem: a review and integration. Hispanic Journal of Behavioral Sciences. 1991;13(2):193–208.CrossRefGoogle Scholar
  48. 48.
    Lara M, Gamboa C, Kahramanian MI, et al. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annual Review of Public Health. 2005;26:367–397.CrossRefPubMedGoogle Scholar
  49. 49.
    Burnett-Zeigler I, Bohnert KM, Ilgen MA. Ethnic identity, acculturation and the prevalence of lifetime psychiatric disorders among Black, Hispanic, and Asian adults in the U.S. Journal of Psychiatric Research. 2013;47(1):56–63.CrossRefPubMedGoogle Scholar
  50. 50.
    Salant T, Lauderdale DS. Measuring culture: a critical review of acculturation and health in Asian immigrant populations. Social Science & Medicine. 2003;57(1):71–90.CrossRefGoogle Scholar
  51. 51.
    Smith TB, Silva L. Ethnic identity and personal well-being of people of color: a meta-analysis. Journal of Counseling Psychology. 2010;58(1):42–60.CrossRefGoogle Scholar
  52. 52.
    Mossakowski KN. Coping with perceived discrimination: does ethnic identity protect mental health? Journal of Health and Social Behavior. 2003;44(3):318–331.CrossRefPubMedGoogle Scholar
  53. 53.
    Keyes KM, Martins SS, Hatzenbuehler ML, et al. Mental health service utilization for psychiatric disorders among Latinos living in the United States: the role of ethnic subgroup, ethnic identity, and language/social preferences. Social Psychiatry and Psychiatric Epidemiology. 2012;47(3):383–394.CrossRefPubMedGoogle Scholar
  54. 54.
    Le Meyer O, Zane N, Cho YI, et al. Use of specialty mental health services by Asian Americans with psychiatric disorders. Journal of Consulting and Clinical Psychology. 2009;77(5):1000–1005.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Berdahl TA, Torres Stone RA. Examining Latino differences in mental healthcare use: the roles of acculturation and attitudes towards healthcare. Community Mental Health Journal. 2009;45(5):393–403.CrossRefPubMedGoogle Scholar
  56. 56.
    Chang J, Natsuaki MN, Chen C-N. The importance of family factors and generation status: mental health service use among Latino and Asian Americans. Cultural Diversity and Ethnic Minority Psychology. 2013;19(3):236–247.CrossRefPubMedGoogle Scholar
  57. 57.
    Alegría M, Mulvaney-Day N, Woo M, et al. Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study. American Journal of Public Health. 2007;97(1):76–83.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Vega WA, Kolody B, Aguilar-Gaxiola S. Help seeking for mental health problems among Mexican Americans. Journal of Immigrant Health. 2001;3(3):133–140.CrossRefPubMedGoogle Scholar
  59. 59.
    Abe-Kim J, Takeuchi DT, Hong S, et al. Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study. American Journal of Public Health. 2007;97(1):91–98.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Lee S, Matejkowski J. Mental health service utilization among noncitizens in the United States: findings from the National Latino and Asian American study. Administration and Policy in Mental Health and Mental Health Services Research. 2012;39(5):406–418.CrossRefPubMedGoogle Scholar
  61. 61.
    Chu JP, Hsieh K-Y, Tokars DA. Help-seeking tendencies in Asian Americans with suicidal ideation and attempts. Asian American Journal of Psychology. 2011;2(1):25–38.CrossRefGoogle Scholar
  62. 62.
    Valencia-Garcia D, Simoni JM, Alegria M, et al. Social capital, acculturation, mental health, and perceived access to services among Mexican American women. Journal of Consulting and Clinical Psychology. 2012;80(2):177–185.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Lebrun LA. Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States. Social Science & Medicine. 2012;74(7):1062–1072.CrossRefGoogle Scholar
  64. 64.
    Richman LS, Kohn-Wood LP, Williams DR. The role of discrimination and racial identity for mental health service utilization. Journal of Social and Clinical Psychology. 2007;26(8):960–981.CrossRefGoogle Scholar
  65. 65.
    Grant BF, Dawson DA. Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health. 2006;29(2):74–78.Google Scholar
  66. 66.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  67. 67.
    Grant B, Dawson D, Stinson F, et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence. 2003;71:7–16.CrossRefPubMedGoogle Scholar
  68. 68.
    Ruan WJ, Goldstein RB, Chou SP, et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence. 2008;92(1–3):27–36.CrossRefPubMedGoogle Scholar
  69. 69.
    Barry DT. An ethnic identity scale for East Asian immigrants. Journal of Immigrant Health. 2002;4(2):87–94.CrossRefPubMedGoogle Scholar
  70. 70.
    Phinney JS. The multigroup ethnic identity measure: a new scale for use with diverse groups. Journal of Adolescent Research. 1992;7(2):156–176.CrossRefGoogle Scholar
  71. 71.
    Rahim-Williams FB, Riley JL, Herrera D, et al. Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics. Pain. 2007;129(1):177–184.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Griner D, Smith TB. Culturally adapted mental health intervention: a meta-analytic review. Psychotherapy: Theory, Research, Practice, Training. 2006;43(4):531–548.CrossRefGoogle Scholar
  73. 73.
    Kohn LP, Oden T, Muñoz RF, et al. Adapted cognitive behavioral group therapy for depressed low-income African American women. Community mental health journal. 2002;38(6):497.CrossRefPubMedGoogle Scholar
  74. 74.
    Su D, Li L, Pagán JA. Social Science & Medicine. 2008;66(2):439–453.CrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  • Inger Burnett-Zeigler
    • 1
  • Yuri Lee
    • 1
  • Kipling M. Bohnert
    • 2
    • 3
  1. 1.Department of Psychiatry and Behavioral SciencesNorthwestern University, Feinberg School of MedicineChicagoUSA
  2. 2.Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) and VA Center for Clinical Management ResearchAnn ArborUSA

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