247727 Understanding Racial/Ethnic Disparities in Mental Health Care At Each Step in the Episode of Care

Wednesday, November 2, 2011: 1:10 PM

Benjamin L. Cook, PhD , Center for Multicultural Mental Health Research, Harvard Medical School, Somerville, MA
Chih-nan Chen, PhD , Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA
Thomas McGuire, PhD , Department of Health Care Policy, Harvard Medical School, Boston, MA
Cross-sectional analyses of mental health care disparities may miss important information (e.g., the probability of initiation of care and the duration of care) that is relevant to understanding disparities and identifying policies to decrease disparities. In this paper, we compare disparities measured using longitudinal data with typically used cross-sectional analyses and comment upon the policy implications of differences in measurement and disparities results.

We combine four two-year longitudinal datasets from Panels 9-12 (2004-2008) of the Medical Expenditure Panel Surveys. We assess three different aspects of mental health utilization episodes among non-Latino whites, African-Americans and Latinos: 1) the probability of initiation of care; 2) the intensity (visits, Rx fills, and expenditures) and duration of care (days) during an episode.

We use survival analysis to estimate mental health care initiation and duration of episode accounting for right censoring. Intensity of care is measured using negative binomial regression models to estimate number of visits and number of prescription drug fills and refills. For comparing mental health care expenditures per episode across groups, we use 2-part generalized linear models (part 1 being initiation and part 2 being expenditures per episode given initiation).

Using longitudinal data, we identified racial/ethnic disparities in initiation of care and duration/intensity of care that were greater in magnitude than disparities identified using cross-sectional data. We recommend the use of episodic analyses when longitudinal data is available given that information related to initiation and dropping of care is potentially more useful to the development of policy solutions.

Learning Areas:
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Understand whether mental health care differences by racial/ethnic group exist in initiation of care, intensity and length of treatment, or discontinuation of care. Assess longitudinal data to increase policy relevance of disparities results

Keywords: Mental Health, Ethnic Identity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract Author because I am trained in health policy and have a track record of grants and publications on mental health care disparities
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.