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Service Utilization Differences for Axis I Psychiatric and Substance Use Disorders Between White and Black Adults

Ms. Keyes and Dr. Alberti are affiliated with the Department of Epidemiology, Columbia University. Mr. Hatzenbuehler is with the Department of Psychology, Yale University, New Haven, Connecticut. Dr. Narrow is with American Psychiatric Institute for Research and Education, Arlington, Virginia. Dr. Grant is with the Laboratory of Epidemiology and Biometry and the Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland. Dr. Hasin, to whom correspondence should be sent, is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute, 1051 Riverside Dr., Box 123, New York, NY 10032 (e-mail: hasind{at}nypdrat.cpmc.columbia.edu).

OBJECTIVE: Although studies have shown disparities between black and white populations in service utilization for mental disorders, little information exists on whether such disparities apply equally across disorders. The objective of this study was to examine racial differences in lifetime prevalence of service utilization for mood and anxiety disorders and for alcohol and drug use disorders, with controls for predisposing, enabling, and need-for-service variables unequally distributed between racial-ethnic groups. METHODS: Data were from a face-to-face epidemiologic survey of 32,752 non-Hispanic white or black adults ages 18 and older residing in households and group quarters in the United States. Main outcome measures were treatment for mood, anxiety, and alcohol and drug use disorders. RESULTS: White adults were consistently more likely than black adults to have had treatment for mood disorders (odds ratio [OR]=2.16, 95% confidence interval [CI]=1.80–2.59) and anxiety disorders (OR=1.77, 95% CI=1.43–2.19) after adjustment for predisposing and enabling factors and need for service (severity of disorder). In contrast no evidence of lower service utilization for treatment of alcohol use disorders emerged among black respondents (OR=.87, 95% CI=.69–1.10). Moreover, white respondents with drug use disorders were significantly less likely than black respondents to receive treatment for a drug problem (OR=.64, 95% CI=.47–.88). CONCLUSIONS: Differences in treatment between black and white adults depended on the specific disorder and type of treatment considered. Prevention and intervention strategies should address disorder-specific disparities in services received.

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August 2008: This Month's Highlights
Psychiatr Serv 2008 59: 835. [Full Text] [PDF]

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