Mental Health Treatment for Rural Poor and Minorities

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DESCRIPTION (provided by applicant): This three-year study will provide a comprehensive, nationally representative, description of rural mental health care, including access to care, patterns of treatment, and outcomes of care. The study will focus on understanding the particular problems faced by rural African Americans and Mexican Americans, women, and the poor in obtaining mental health treatment. We also will evaluate these relationships using guideline-concordant care as the standard for those with depressive and anxiety disorders. The Behavioral Model of Utilization is used as a framework to understand the complex relationship among environmental factors, population characteristics, services use, and outcomes. The proposed research is organized around three specific aims. First, we will describe variation in the likelihood of mental health treatment with respect to residential, ethnic minority status, poverty, and gender. Our second aim is to understand the role of access in explaining variation in mental health treatment with respect to residential, ethnic minority status, poverty, and gender status. Finally, our third aim is to examine the effect of treatment for depression and anxiety on several outcomes for adults, and parental treatment on child outcomes. Our analysis will use data from four panels of the Medical Expenditure Panel Survey (MEPS) supplemented with information from the National Health Interview Survey. A strength of the proposed research is its use of county-level measures of rurality. Pooled across four years, the MEPS includes approximately 10,000 respondents residing in non-metropolitan areas, offering a unique opportunity to understand variation in mental health treatment across rural subpopulations. The availability of detailed medical histories will allow us to examine use of mental health services over a 2 1/2 year period. The populations studied, ethnic minorities and rural residents, are priority areas for the National Institute of Mental Health. By addressing the pressing need to reduce disparities in mental health care, our research will inform mental health policy with regard to services delivery systems for rural impoverished and minority populations.