Skip to main content
Health Services Research logoLink to Health Services Research
. 1994 Jun;29(2):135–153.

Ethnic differences in use of inpatient mental health services by blacks, whites, and Hispanics in a national insured population.

D K Padgett 1, C Patrick 1, B J Burns 1, H J Schlesinger 1
PMCID: PMC1069995  PMID: 8005786

Abstract

OBJECTIVE. We examine whether ethnic differences in use of inpatient mental health services exist when the usually confounding effects of minority status and culture are minimized or controlled. DATA SOURCES AND STUDY SETTING. Secondary analyses were conducted using a national insurance claims database for 1.2 million federal employees and their dependents insured by the Blue Cross/Blue Shield (BC/BS) Federal Employees Plan (FEP). STUDY DESIGN. The Andersen-Newman model of health utilization was used to analyze predisposing, enabling, and need variables as predictors of inpatient mental health utilization during 1983. The study design was cross-sectional. DATA COLLECTION. The study database was made up of BC/BS insurance claims, Office of Personnel Management employee data, and Area Resource File data. PRINCIPAL FINDINGS. No significant differences were found among blacks, whites, and Hispanics in the probability of a psychiatric hospitalization or in the number of inpatient psychiatric days. Regression analyses revealed younger age and psychiatric treatment of other family members as significant predictors of a hospitalization; region of residence, younger age, hospital bed availability, and high option plan enrollment were significant predictors of the number of treatment days. CONCLUSIONS. Ethnic differences in use of inpatient mental health services were not significant in this generously insured population. Further research involving primary data collection among large and diverse samples of ethnic individuals is needed to fully examine the effects of cultural and socioeconomic differences on use of mental health services.

Full text

PDF
135

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acosta F. X. Barriers between mental health services and Mexican Americans: an examinations of a paradox. Am J Community Psychol. 1979 Oct;7(5):503–520. doi: 10.1007/BF00894047. [DOI] [PubMed] [Google Scholar]
  2. Adebimpe V. R. Overview: white norms and psychiatric diagnosis of black patients. Am J Psychiatry. 1981 Mar;138(3):279–285. doi: 10.1176/ajp.138.3.279. [DOI] [PubMed] [Google Scholar]
  3. Andersen R., Newman J. F. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973 Winter;51(1):95–124. [PubMed] [Google Scholar]
  4. Cheung F. K., Snowden L. R. Community mental health and ethnic minority populations. Community Ment Health J. 1990 Jun;26(3):277–291. doi: 10.1007/BF00752778. [DOI] [PubMed] [Google Scholar]
  5. Dunn J., Fahy T. A. Police admissions to a psychiatric hospital. Demographic and clinical differences between ethnic groups. Br J Psychiatry. 1990 Mar;156:373–378. doi: 10.1192/bjp.156.3.373. [DOI] [PubMed] [Google Scholar]
  6. Flaskerud J. H., Hu L. T. Racial/ethnic identity and amount and type of psychiatric treatment. Am J Psychiatry. 1992 Mar;149(3):379–384. doi: 10.1176/ajp.149.3.379. [DOI] [PubMed] [Google Scholar]
  7. Flaskerud J. H., Hu L. T. Relationship of ethnicity to psychiatric diagnosis. J Nerv Ment Dis. 1992 May;180(5):296–303. doi: 10.1097/00005053-199205000-00003. [DOI] [PubMed] [Google Scholar]
  8. Horgan C. M. Specialty and general ambulatory mental health services. Comparison of utilization and expenditures. Arch Gen Psychiatry. 1985 Jun;42(6):565–572. doi: 10.1001/archpsyc.1985.01790290047005. [DOI] [PubMed] [Google Scholar]
  9. Hough R. L., Landsverk J. A., Karno M., Burnam M. A., Timbers D. M., Escobar J. I., Regier D. A. Utilization of health and mental health services by Los Angeles Mexican Americans and non-Hispanic whites. Arch Gen Psychiatry. 1987 Aug;44(8):702–709. doi: 10.1001/archpsyc.1987.01800200028005. [DOI] [PubMed] [Google Scholar]
  10. Hu T. W., Snowden L. R., Jerrell J. M., Nguyen T. D. Ethnic populations in public mental health: services choice and level of use. Am J Public Health. 1991 Nov;81(11):1429–1434. doi: 10.2105/ajph.81.11.1429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jones B. E., Gray B. A. Problems in diagnosing schizophrenia and affective disorders among blacks. Hosp Community Psychiatry. 1986 Jan;37(1):61–65. doi: 10.1176/ps.37.1.61. [DOI] [PubMed] [Google Scholar]
  12. Kiesler C. A., Simpkins C. The de facto national system of psychiatric inpatient care. Piecing together the national puzzle. Am Psychol. 1991 Jun;46(6):579–584. doi: 10.1037//0003-066x.46.6.579. [DOI] [PubMed] [Google Scholar]
  13. Knesper D. J., Wheeler J. R., Pagnucco D. J. Mental health services providers' distribution across countries in the United States. Am Psychol. 1984 Dec;39(12):1424–1434. doi: 10.1037//0003-066x.39.12.1424. [DOI] [PubMed] [Google Scholar]
  14. Lindsey K. P., Paul G. L. Involuntary commitments to public mental institutions: issues involving the overrepresentation of blacks and assessment of relevant functioning. Psychol Bull. 1989 Sep;106(2):171–183. doi: 10.1037/0033-2909.106.2.171. [DOI] [PubMed] [Google Scholar]
  15. Mason M. A., Gibbs J. T. Patterns of adolescent psychiatric hospitalization: implications for social policy. Am J Orthopsychiatry. 1992 Jul;62(3):447–457. doi: 10.1037/h0079361. [DOI] [PubMed] [Google Scholar]
  16. Meinhardt K., Vega W. A method for estimating underutilization of mental health services by ethnic groups. Hosp Community Psychiatry. 1987 Nov;38(11):1186–1190. doi: 10.1176/ps.38.11.1186. [DOI] [PubMed] [Google Scholar]
  17. Mukherjee S., Shukla S., Woodle J., Rosen A. M., Olarte S. Misdiagnosis of schizophrenia in bipolar patients: a multiethnic comparison. Am J Psychiatry. 1983 Dec;140(12):1571–1574. doi: 10.1176/ajp.140.12.1571. [DOI] [PubMed] [Google Scholar]
  18. Padgett D. K., Patrick C., Burns B. J., Schlesinger H. J., Cohen J. The effect of insurance benefit changes on use of child and adolescent outpatient mental health services. Med Care. 1993 Feb;31(2):96–110. doi: 10.1097/00005650-199302000-00002. [DOI] [PubMed] [Google Scholar]
  19. Padgett D. K., Patrick C., Burns B. J., Schlesinger H. J. Ethnicity and the use of outpatient mental health services in a national insured population. Am J Public Health. 1994 Feb;84(2):222–226. doi: 10.2105/ajph.84.2.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Patrick C., Padgett D. K., Burns B. J., Schlesinger H. J., Cohen J. Use of inpatient services by a national population: do benefits make a difference? J Am Acad Child Adolesc Psychiatry. 1993 Jan;32(1):144–154. doi: 10.1097/00004583-199301000-00021. [DOI] [PubMed] [Google Scholar]
  21. Patrick C., Padgett D. K., Schlesinger H. J., Cohen J., Burns B. J. Serious physical illness as a stressor: effects on family use of medical services. Gen Hosp Psychiatry. 1992 Jul;14(4):219–227. doi: 10.1016/0163-8343(92)90091-n. [DOI] [PubMed] [Google Scholar]
  22. Rosenfield S. Race differences in involuntary hospitalization: psychiatric vs. labeling perspectives. J Health Soc Behav. 1984 Mar;25(1):14–23. [PubMed] [Google Scholar]
  23. Scheffler R. M., Miller A. B. Demand analysis of mental health service use among ethnic subpopulations. Inquiry. 1989 Summer;26(2):202–215. [PubMed] [Google Scholar]
  24. Schwartz A. H., Perlman B. B., Paris M., Schmidt K., Thornton J. C. Psychiatric diagnoses as reported to Medicaid and as recorded in patient charts. Am J Public Health. 1980 Apr;70(4):406–408. doi: 10.2105/ajph.70.4.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Snowden L. R., Cheung F. K. Use of inpatient mental health services by members of ethnic minority groups. Am Psychol. 1990 Mar;45(3):347–355. doi: 10.1037//0003-066x.45.3.347. [DOI] [PubMed] [Google Scholar]
  26. Sue D., Sue S. Cultural factors in the clinical assessment of Asian Americans. J Consult Clin Psychol. 1987 Aug;55(4):479–487. doi: 10.1037/0022-006X.55.4.479. [DOI] [PubMed] [Google Scholar]
  27. Sue S. Community mental health services to minority groups. Some optimism, some pessimism. Am Psychol. 1977 Aug;32(8):616–624. doi: 10.1037//0003-066x.32.8.616. [DOI] [PubMed] [Google Scholar]
  28. Taube C. A., Kessler L. G., Burns B. J. Estimating the probability and level of ambulatory mental health services use. Health Serv Res. 1986 Jun;21(2 Pt 2):321–340. [PMC free article] [PubMed] [Google Scholar]
  29. Temkin-Greener H., Clark K. T. Ethnicity, gender, and utilization of mental health services in a Medicaid population. Soc Sci Med. 1988;26(10):989–996. doi: 10.1016/0277-9536(88)90216-x. [DOI] [PubMed] [Google Scholar]
  30. Tweed D. L., Goldsmith H. F., Jackson D. J., Stiles D., Rae D. S., Kramer M. Racial congruity as a contextual correlate of mental disorder. Am J Orthopsychiatry. 1990 Jul;60(3):392–403. doi: 10.1037/h0079173. [DOI] [PubMed] [Google Scholar]
  31. Vernon S. W., Roberts R. E. Prevalence of treated and untreated psychiatric disorders in three ethnic groups. Soc Sci Med. 1982;16(17):1575–1582. doi: 10.1016/0277-9536(82)90168-x. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES