Mechanisms Underlying Racial/Ethnic Disparities in Mental Disorders

 说明(由申请人提供)：作为《平价医疗法案》的一部分，卫生与公众服务部(HHS)必须制定和评估一项行动计划，以减少种族/民族健康差距，包括增加预防保健和对社区卫生团队的投资，使少数族裔社区受益。但要想让这样的计划有效，需要有深思熟虑的目标。拟议的研究有可能为制定实现心理健康公平的干预措施奠定坚实的研究基础，这些干预措施可以作为HHS议程的一部分实施，以减少差异。近40%的美国人口在一生中患有精神障碍，其中种族/少数民族群体患严重持续性精神障碍和未经治疗的精神疾病的风险特别高。但基本问题仍然没有得到回答，因为很少有研究调查这些差异背后的机制。本文建议的研究旨在通过考察四组假设在造成精神障碍的种族/民族差异中发挥重要作用的机制来关注这一知识鸿沟：(1)低社会经济地位(SES)；(2)童年逆境(例如，虐待、家庭暴力)；(3)弱势角色星座(例如，早育、离婚)；以及(4)弱势邻里环境(例如，居住隔离、集中劣势)。我们建议通过对五项调查的社区流行病学数据进行二次分析来研究四种机制，这些调查提供了关于这些终生疾病的广泛终身发作的无与伦比的信息，以及这些疾病一旦发生时在持久性和严重性方面的差异。我们还研究了精神卫生保健的障碍，因为未经治疗的精神疾病对少数群体社区具有破坏性影响。但是，由于经验研究结果通常不能弥合提供信息的人和可能使用信息的人之间的距离，我们的最后一个目标是确定如何最好地构建和使用我们的研究结果，作为干预和/或政策变化的可行目标。我们将与社区、消费者和政策团体合作，为预防、服务和政策干预提出建议，旨在减少心理健康结果和服务中的种族/民族差异。

 DESCRIPTION (provided by applicant): As part of the Affordable Health Care Act, the Department of Health and Human Services (HHS) must develop and evaluate an action plan to reduce racial/ethnic health disparities, including increased preventive care and investments in community health teams that can benefit minority communities. But for such a plan to be effective, thoughtful targeting is needed. The proposed research has the potential to build a solid research foundation for developing interventions to achieve mental health equity that could be implemented as part of the HHS agenda to reduce disparities. Nearly 40% of the US population develops a mental disorder in their lifetime, with racial/ethnic minority groups at particularly high risk of severe-persistent mental disorders and untreated mental illness. But fundamental questions remain unanswered given that few studies investigate the mechanisms that underlie these disparities. The research proposed here aims to attend to this knowledge gap by examining four sets of mechanisms hypothesized to play important roles in causing racial/ethnic disparities in mental disorders: (1) low socio-economic status (SES); 2) childhood adversities (e.g., maltreatment, family violence); (3) disadvantaged role constellations (e.g., early child-bearing, divorce); and (4) disadvantaged neighborhood context (e.g., residential segregation, concentrated disadvantage). We propose to study four mechanisms by carrying out secondary analysis of community epidemiological data across five surveys that provide unparalleled information about the lifetime onset of a wide range of these lifetime disorders, and disparities in the persistence and severity of these disorders once they occur. We also examine barriers to mental health care since untreated mental illness has devastating effect on minority communities. But because empirical findings typically do not bridge the distance between the people who produce the information and the people who could use the information, our last aim identifies how best to frame and use our research results as actionable targets for Intervention and/or policy change. We will work with community, consumer, and policy groups to generate recommendations for prevention, service, and policy interventions aimed at reducing racial/ethnic disparities in mental health outcomes and services.