NLAAS II: Unraveling Differences for Clinical Services

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DESCRIPTION (provided by applicant): This continuation application requests three-years of support to investigate differences in the correlates of psychiatric illness and mental health service disparities among Asian Americans and Latinos as compared to non-Latino Whites. We will use recently collected data from the National Latino and Asian American Study (NLAAS), a national psychiatric epidemiologic study conducted to measure psychiatric disorders and mental health service usage in a representative sample of Asians and Latinos, and the National Comorbidity Study Replication (NCS-R). The combined NLAAS/NCS-R data are the best available to address critical questions regarding the level of service disparities, and the identification of service disparities "hot spots." In this resubmission, we apply an innovative conceptual framework to organize correlates for psychiatric illness, mental health service use and mental health service disparities, giving attention to health system and contextual factors in addition to traditional individual level factors. Specifically, our aims are to: (1) Use combined data from the NLAAS and the NCS-R to: compare prevalence of psychiatric disorders and mental health service use among Latinos, Asian, and non-Latino Whites; investigate hypotheses related to differences in the correlates of illness and mental health services; and assess bias in disorder prevalence and service use, (2) Apply the IOM definition of disparities to quantify disparities in services utilization and identify potential mechanisms underlying services disparities, and (3) Apply methods from spatial epidemiology to identify "hot spots" of mental health service disparities at the MSA level, and investigate health care system factors associated with high and low performing MSAs. This study will provide national baseline data on which to define the progress and measurable targets for mental health service disparity improvements for Latinos and Asian Americans as compared to non-Latino Whites. In addition, it will identify health system factors measured at the community and individual level that mediate disparities and can be targeted by policymakers. Finally, it will provide policymakers with information regarding where in the US mental health service disparities are unusually high. These findings can be used to target resources, develop coherent public policies, and inform guidelines aimed at making mental health prevention and treatment services more responsive and sensitive to the needs of ethnic/racial minorities.