Familial Influences in the Use of Mental Health Services among African Americans in the United States

The processes that influence mental health treatment among African Americans are not well understood despite the greater severity and duration of disorders in this population. This study examined one potentially pivotal social influence—the family. Data are from the National Survey of American Life, a survey of a nationally representative sample of African Americans that assessed psychiatric disorders and service use. The full sample (N=3,165) and only those meeting DSM-IV diagnostic criteria for any past-year mood, anxiety, or substance-use disorder (N=611) was analyzed using logistic regression. For the full sample, family closeness/support was associated with lower odds of using any mental health service in the past year, and family conflict with higher odds. These effects became statistically nonsignificant when current diagnostic status was added, suggesting that it mediates the effects of family dynamics on service utilization. Having a family history of psychiatric disorders and treatment was a strong predictor of service use, even after controlling for potential confounders. Although clinical need, indexed by meeting diagnostic criteria, had the strongest effect, the family history effect was larger than self-rated mental health. For respondents meeting diagnostic criteria, the odds of any service use were higher for those who met criteria for multiple disorders, were educated, and older, whereas living alone was associated with lower odds. Family may indirectly influence service use for African Americans by influencing mental health status. However, among those who meet criteria for a psychiatric disorder, use of mental health services is driven by influences outside of the family.