Understanding Mechanisms of Mental Health Care Disparities

说明(申请人提供)：精神卫生保健方面的种族/族裔差异，相对而言，超过了许多其他卫生保健服务领域的差异，即使考虑到精神健康状况，非洲裔和西班牙裔获得精神卫生保健的比率也只有非西班牙裔白人的一半。这些服务使用方面的差异可能导致非洲裔美国人和拉美裔美国人精神障碍的持久性、严重性和疾病负担更大。在这项拟议的研究中，我们满足了对关于精神卫生保健服务中潜在差异的机制的直接、容易理解的信息的需求。我们通过评估护理事件中的种族/民族差异而不是横断面数据来改进先前的研究，使我们能够了解与患者和提供者的实际行为更密切相关的与护理开始、持续时间、强度和质量相关的因素。此外，我们建议首次全面审视地理差异对精神卫生保健中种族/民族差异的贡献，区分个人居住的州和社区造成的差异和个人特征造成的差异，并确定可受政策变化影响的地区特征。最后，我们与政策制定者合作开发了一个精神卫生保健差距指数，该指数提供了一个易于理解的各州精神卫生保健差距的比较，以直接为政策制定者减少差距干预提供信息。我们的具体目标是： 1.评估心理健康护理的开始、强度、持续时间和质量方面的差异 2.评估地理位置在差异中的作用，确定地区一级精神卫生服务使用情况的相关因素 3.制定各州精神卫生保健支出和质量差异指数。 公共卫生相关性：在这个项目中，我们试图确定和理解导致精神卫生保健事件中种族/民族差异的潜在机制。我们在这个项目中的重点是使用最先进的差异研究方法，通过整合精神卫生保健治疗的纵向和邻里层面的数据来改进先前的研究。我们的目标是将我们的发现转化为直接可用的信息，向政策制定者提供如何减少精神卫生保健差距的信息，包括制定精神卫生保健差距指数，逐个州比较精神卫生保健支出和质量的差距。

DESCRIPTION (provided by applicant): Racial/ethnic disparities in mental health care, in relative terms, exceed disparities in many other areas of health care services, with African-Americans and Hispanics accessing mental health care at only half the rate of non-Hispanic Whites, even after accounting for mental health status. These disparities in service use likely contribute to the greater persistence, severity, and disease burden of mental disorder among African- Americans and Latinos. In this proposed study, we fulfill a need for direct, easily understandable information about the mechanisms underlying disparities in mental health care services. We improve upon previous research by assessing racial/ethnic disparities in episodes of care rather than cross-sectional data, allowing us to understand factors related to initiation, duration, intensity, and quality of care that are more closely linked with the actual behaviors of patients and providers. In addition, we propose the first comprehensive look at the contribution of geographic disparities to racial/ethnic disparities in mental health care, distinguishing disparities due to the state and neighborhood where an individual lives from disparities due to individual characteristics and identifying area-level characteristics that are amenable to policy change. Finally, we develop, in collaboration with policymakers, a mental health care disparities index that provides an easy to understand state-by-state comparison of mental health care disparities to directly inform policymakers' disparities reduction interventions. Our specific aims are to: 1. Assess disparities in initiation, intensity, duration, and quality of mental health care episodes 2. Assess role of geography in disparities identifying area-level correlates of mental health service use 3. Develop indices of disparities in states' mental health care expenditure and quality. PUBLIC HEALTH RELEVANCE: In this project, we attempt to identify and understand the underlying mechanisms driving racial/ethnic disparities in mental health care episodes. Our focus in this project is to use state-of-the-art methods of disparity research, improving upon previous studies by incorporating longitudinal and neighborhood-level data on mental health care treatment. We aim to translate our findings to provide directly useable information to policymakers on how to reduce mental health care disparities, including the development of a mental health care disparities index, a state-by-state comparison of disparities in mental health care expenditures and quality.