Understanding Mechanisms of Mental Health Care Disparities

描述（由申请人提供）：种族/民族在精神卫生保健方面的差异，相对而言，超过了许多其他领域的医疗保健服务的差异，非洲裔美国人和西班牙裔美国人获得精神卫生保健的速度只有非西班牙裔白人的一半，即使在考虑精神健康状况后。这些服务使用上的差异可能导致非裔美国人和拉丁美洲人精神障碍的持续性、严重性和疾病负担更大。在这项拟议的研究中，我们满足了直接的，易于理解的信息的机制，在精神卫生保健服务的差异。我们通过评估护理事件中的种族/民族差异而不是横截面数据来改进以前的研究，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护理启动，持续时间，强度和质量相关的因素。此外，我们提出了第一个全面审视的贡献，地理差异的种族/民族差异的精神卫生保健，区分差异，由于国家和社区，其中一个人的生活差异，由于个人特征和识别区域水平的特点，是经得起政策的变化。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，以直接告知政策制定者减少差异的干预措施。我们的具体目标是： 1.评估精神卫生保健事件的开始、强度、持续时间和质量的差异 2.评估地理在差异中的作用，确定心理健康服务使用的地区层面相关因素 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，我们试图识别和理解驱动种族/民族差异的潜在机制，在精神卫生保健事件。我们在这个项目中的重点是使用最先进的差距研究方法，通过纳入纵向和邻里水平的数据对精神卫生保健治疗，改善以前的研究。我们的目标是将我们的研究结果转化为政策制定者提供直接可用的信息，以减少精神卫生保健差异，包括制定精神卫生保健差异指数，逐州比较精神卫生保健支出和质量的差异。

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.