- This study examined factors that influenced mental health service use among a racially/ethnically diverse sample of 1,013 older adults screened at community-based organizations or primary care clinics as part of the Positive Minds–Strong Bodies trial
- The three groups of factors analyzed were predisposing factors (age, gender, race/ethnicity, and education), factors that can prevent help-seeking (e.g., cognitive impairment), and higher levels of depression, anxiety, and post-traumatic stress disorder
- As expected, racial/ethnic minority groups overall reported lower odds of using mental health services compared with white participants
- Yet only Latino/a/x and Asian, and not Black participants, were less likely to report receiving mental health services compared with white participants, perhaps because of language barriers
- Community-based organizations, which provide help for daily needs such as language translation and meals, can play an active role in connecting older adults with mental health services
How people experience and respond to mental distress varies across racial and ethnic groups, reflecting structural inequities (e.g., in access to quality care) and cultural differences (e.g., in worldview).
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Margarita Alegría, PhD, chief of the Disparities Research Unit at Massachusetts General Hospital, Liao Zhang, MD, PsyaD, a clinical research associate in that unit and research fellow in the Department of Medicine, and colleagues recently used the Behavioral Model for Vulnerable Populations (BMV) as a guiding framework to characterize various factors that might affect mental health service use among older adults of color. Their report appears in the Journal of Applied Gerontology.
The data analyzed came from the screening assessment of Positive Minds–Strong Bodies, a randomized controlled trial of a combined mental health–physical exercise intervention for adults ages ≥60.
Participants were recruited for the trial at community-based organizations (CBOs; e.g., senior day centers) and primary health clinics that mainly serve low-income racial/ethnic minority and immigrant older adults in Massachusetts, New York, Florida, and Puerto Rico. The screening was conducted between May 2015 and May 2018 in English, Spanish, Mandarin, or Cantonese and incorporated translated and psychometrically tested measures.
1,057 potential trial participants were screened: 46% reported being Asian/Pacific Islander, 27% Hispanic/Latinx, 15% Black, 8% white, and 4% Native American. The latter group was excluded because of the low number, leaving 1,013 individuals for analysis.
Mental Health Service Use
85% of the respondents screened indicated they were not currently using mental health services. 80% of individuals in that subgroup were linguistic minorities.
The researchers defined the need for mental health services as a score ≥5 on the Patient Health Questionnaire 9-item (depressive symptoms), Generalized Anxiety Disorder 7-item, and/or Geriatric Depression Scale 15-item:
- 49% of respondents were classified as in need of services
- Asian respondents had the lowest rate of mental health service use (16%), followed by Black (25%), Latinx (31%), and white respondents (37%)
- Among respondents classified as without symptomology for needing mental health services, white respondents reported the highest rate of use (32%), followed by Black (10%), Latinx (9%), and Asian respondents (0.7%)
Service Use and Predisposing Factors
The BMV considers factors that might predispose to mental health service use, such as race/ethnicity, age, gender, and education level. Race/ethnicity was the only one of these factors significantly associated:
- Asian (OR=0.15; P<0.01) and Latinx respondents (OR=0.35; P<0.01) had lower odds of mental health service use than white respondents
- Contrary to other research, there was no significant difference between Black and white respondents in the use of services
The different results for Black versus Asian and Latinx respondents may be attributable to language barriers in the latter groups.
Service Use and Enabling Factors
The BMV defines enabling factors as those that might promote (or interfere with) independent help-seeking. Unexpectedly, cognitive impairment and suicidal ideation were not significantly associated with the use of mental health services.
Service Use and Need for Services
As expected, respondents with more symptoms of anxiety, depression, or post-traumatic stress disorder reported a greater likelihood of mental health service use. However, these associations varied by race/ethnicity:
- Lower levels of symptom severity—use of services was higher among white respondents than Latinx or Asian respondents
- Higher levels of symptom severity—Latinx and Asian respondents were more likely than white respondents to use services, but Black older adults did not report greater use than white older adults
Compared with Asian and Latinx respondents, Black respondents were less likely to face linguistic barriers. Still, they might face social and cultural barriers such as stigma about mental illness and microaggressions in therapy.
These findings suggest CBOs can play an active role in connecting older adults with mental health services and reducing service use disparities. When racial/ethnic minority older adults visit CBOs for help with daily living (e.g., meals, translation of paperwork), their mental health needs may also be recognized.
Primary care facilities and mental health clinics should consider partnering with and investing in CBOs (e.g., training CBO staff to identify mental health needs) to reduce racial disparities in mental health care.
Learn about the Disparities Research Unit
Explore research in the Division of Palliative Care & Geriatric Medicine