Beyond language barriers and access to care: Less mental health care utilization by immigrants in primary care

OBJECTIVE:To determine the relationship between immigrant status and mental health care utilization in English-speaking patients. METHODS:. We screened patients at an academic-affiliated safety net hospital for a study examining the prevalence of post-traumatic stress disorder. Eligible subjects were 18-65 years old, English speaking and had an appointment with a primary care clinician. The independent variable, immigrant status, was defined as being born outside the US or Puerto Rico. The dependent variable, mental health care utilization, was defined as at least one visit to a mental health professional and/or prescription of psychoactive medication, as noted in the electronic medical record, in the 12 months prior to the research interview . RESULTS:. Seventy-four (52%) immigrants and 219 (61%) native-born participants met diagnostic criteria for at least one of the following mental health disorders: PTSD, major and/or other depression, anxiety disorder (p=0.10). Of the entire sample, 48 (33%) immigrants and 174 (48%) native-born participants utilized mental health care (p=0.004). Of the those participants with at least one mental health disorder, 34 (46%)immigrants and 132 (61%) native-born participants utilized mental health care (p=0.03). CONCLUSIONS: Despite their English language fluency and access to health care, immigrant patients utilized less mental health care than their native-born counterparts even among those with mental health disorders. Additional research on immigrant mental health utilization should consider both patient factors and clinician factors that might influence immigrant mental health care utilization.