Understanding Mechanisms of Mental Health Care Disparities

描述（由申请人提供）：相对而言，精神卫生保健方面的种族/族裔差异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，非洲裔美国人和西班牙裔美国人获得精神卫生保健的比例仅为非西班牙裔白人的一半。这些服务使用上的差异可能导致非裔美国人和拉丁裔美国人精神障碍的持久性、严重性和疾病负担更大。在这项研究中，我们满足了对心理卫生保健服务差异机制的直接、容易理解的信息的需求。我们改进了之前的研究，通过评估种族/民族在治疗过程中的差异，而不是横断面数据，使我们能够理解与开始、持续时间、强度和护理质量相关的因素，这些因素与患者和提供者的实际行为更密切相关。此外，我们建议首次全面研究地理差异对精神卫生保健中种族/民族差异的贡献，将个体生活的州和社区差异与个体特征差异区分开来，并确定可适应政策变化的区域层面特征。最后，我们与政策制定者合作开发了一个精神卫生保健差异指数，该指数提供了一个易于理解的各州精神卫生保健差异比较，从而直接为政策制定者提供减少差异的干预措施。我们的具体目标是：

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.