Barriers to mental health service use: variations by age and race/ethnicity

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This study examines the variation by age and racial/ethnic minority status in factors affecting misuse of mental health services (MHS) to identify barriers to adequate mental healthcare among racially/ethnically diverse older adults. Drawn from the nationally representative Collaborative Psychiatric Epidemiology Surveys (CPES), a racially/ethnically diverse group of adults who demonstrated either an objective (psychiatric diagnosis) or perceived need for MHS (n=5,545) was selected for analyses. Binary logistic regression analyses were conducted, with a focus on the interaction of older age with racial/ethnic minority status. To further explore the issue, we used chi-squared tests of proportional differences to compare the rates at which varying racial/ethnic groups and age groups encountered various attitudinal and structural barriers to proper MHS use. We found that Asian, Hispanic/Latino, and Black respondents were significantly more likely to misuse MHS than non-Hispanic Whites (ORs [95% CIs]=1.960 [1.471, 2.609], 2.362 [1.955, 2.854], & 2.906 [2.475, 3.412], respectively). Older adults were less likely than younger adults to misuse MHS (OR=0.991; 95%CI=0.986, 0.995). All differences were significant at p<0.001. There were significant age by race/ethnicity interactions on overall misuse of MHS. Post hoc analyses indicate that many attitudinal and structural barriers showed greater disparity between racial/ethnic minorities and whites in older adults than in younger adults. These results suggest that older age and membership in a racial/ethnic minority group interact to predict greater deficits in openness and access to MHS. Efforts to improve MHS underutilization by these groups should take their unique obstacles into account in order to reduce existing disparities.

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