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

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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.