Disparities in Mental Health Care: Age, Race/Ethnicity, and Geography Effects

描述（由申请人提供）：本申请涉及国家老龄化研究所（NIA）的优先领域：减少或消除老年人中种族/少数民族和非少数民族之间的健康差距。这一申请的重点是精神卫生保健，少数种族/族裔获得精神卫生服务的比率仅为非西班牙裔白人的一半，即使在控制了精神卫生状况之后。虽然现有文献记录了与精神卫生保健相关的个人水平特征，但地区水平（即，对这种护理的地理特征知之甚少。因此，在这项拟议的研究中，我们将评估地理因素对老年人精神卫生保健中种族和民族差异的贡献。这项研究的总体目标是提高我们对种族/民族和地理因素之间复杂但尚未探索的关系的理解。该项目将通过将全国代表性的精神卫生保健调查数据与美国人口普查和地区资源文件中的地区数据联系起来来完成。该研究有两个具体目标：目标1。确定在地区，州和县一级的精神卫生保健种族/民族差异的地理“热点”。在完成目标1之后，我们将能够确定需要新政策来减少老年人之间种族/民族差异的地理区域（在州或县一级）。目标二。评估与地区、州和县各级精神卫生保健中种族/民族差异相关的地理特征。在完成目标2后，我们将能够确定地区一级的风险因素，这些因素可能是可以改变的，在制定政策以减少差距时应该加以考虑。除了科学目标，这个职业发展奖将提供先进的方法，医学地理学和流行病学的培训。在培训期间获得的技能将使候选人能够在老龄化，心理健康和地理的交叉点进行尖端研究，以找到减少或消除老年人之间现有差距的方法。我组建的跨学科指导团队以及我与UA心理健康和老龄化中心和深南RCMAR的联系为支持这些努力提供了基础设施。

DESCRIPTION (provided by applicant): This application addresses a priority area for the National Institute on Aging (NIA): to reduce or eliminate health disparities between racial/ethnic minorities and nonminorities among older adults. The focus of this application is on mental health care, where racial/ethnic minorities access mental health services at only half the rate of non- Hispanic Whites, even after controlling for mental health status. While existing literature documents individual- level characteristics associated with mental health care, area-level (i.e., geographic) characteristics of such care are poorly understood. Thus, in this proposed study, we will assess the contribution of geographic factors to racial and ethnic disparities in mental health care among older adults. The overall goal of this research is to improve our understanding of the complex, yet unexplored, relations between race/ethnicity and geographic factors. This project will be accomplished by linking nationally representative survey data on mental health care to area-level data drawn from the U.S. Census and the Area Resource File. The proposed research has two specific aims: Aim 1. Identify geographic 'hot spots' of racial/ethnic disparities in mental health care at the regional, state, and county levels. After completing Aim 1, we will be able to identify geographic areas (at the state or county level) that need new policies to reduce racial/ethnic disparities among older adults. Aim 2. Assess geographic characteristics associated with racial/ethnic disparities in mental health care at the regional, state, and county levels. After completing Aim 2, we will be able to identify area-level risk factors that are potentially modifiable and should be considered in development of policies to reduce disparities. Beyond the scientific aims, this career development award will provide training in advanced methodology, medical geography, and epidemiology. The skills obtained during the training period will enable the candidate to perform cutting-edge research at the intersection of aging, mental health and geography to find ways to reduce or eliminate existing disparities among older adults. The interdisciplinary mentoring team I put together and my affiliations with the UA Center for Mental Health and Aging and the Deep South RCMAR provide the infrastructure to support these endeavors.