NLAAS II: Unraveling Differences for Clinical Services

描述（由申请人提供）：本延续申请要求三年的支持，以调查亚裔美国人和拉丁美洲人与非拉丁美洲白人相比，精神疾病和精神卫生服务差异的相关性差异。我们将使用最近从国家拉丁裔和亚裔美国人研究（NLAAS）收集的数据，这是一项国家精神病学流行病学研究，旨在测量亚洲人和拉丁裔代表性样本中的精神疾病和精神卫生服务使用情况，以及国家科摩罗研究复制（NCS-R）。结合NLAAS/NCS-R数据是解决有关服务差异水平的关键问题和确定服务差异“热点”的最佳方法。“在这次重新提交中，我们采用了一个创新的概念框架来组织精神疾病，精神卫生服务使用和精神卫生服务差异的相关性，除了传统的个人水平因素外，还关注卫生系统和背景因素。具体而言，我们的目标是：（1）使用NLAAS和NCS-R的综合数据：比较拉丁美洲人，亚洲人和非拉丁美洲白人之间精神疾病和精神卫生服务使用的患病率;调查与疾病和精神卫生服务相关性差异相关的假设;并评估疾病患病率和服务使用的偏差，（2）应用IOM对差异的定义来量化服务使用的差异，并确定潜在的服务差异机制，（3）运用空间流行病学的方法，在MSA水平上确定精神卫生服务差异的“热点”，并调查与高绩效和低绩效MSA相关的卫生保健系统因素。这项研究将提供国家基线数据，以确定拉丁裔和亚裔美国人与非拉丁裔白人相比，精神卫生服务差距改善的进展和可衡量的目标。此外，它还将确定在社区和个人层面衡量的卫生系统因素，这些因素介导了差异，并可成为决策者的目标。最后，它将为政策制定者提供有关美国精神卫生服务差异异常高的信息。这些研究结果可用于定向资源，制定连贯的公共政策，并为旨在使心理健康预防和治疗服务对少数民族/种族的需求更加敏感和敏感的指导方针提供信息。

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.