Clinical significance of psychotic-like experiences across U.S. ethnoracial groups.

BACKGROUND: Prevalence of psychotic-like experiences (PLEs) - reports of hallucinations and delusional thinking not meeting criteria for psychotic disorder - varies substantially across ethnoracial groups. What explains this range of PLE prevalence? Despite extensive research, the clinical significance of PLEs remains unclear. Are PLE prevalence and clinical severity differentially associated across ethnoracial groups? METHODS: We examined the lifetime prevalence and clinical significance of PLEs across ethnoracial groups in the Collaborative Psychiatric Epidemiology Surveys (N = 11 139) using the Composite International Diagnostic Interview (CIDI) psychosis symptom screener. Outcomes included mental healthcare use (inpatient, outpatient), mental health morbidity (self-perceived poor/fair mental health, suicidal ideation or attempts), and impairment (role interference). Individuals with outcome onsets prior to PLE onset were excluded. We also examined associations of PLEs with CIDI diagnoses. Cox proportional-hazards regression and logistic regression modeling identified associations of interest. RESULTS: Contrary to previous reports, only Asian Americans differed significantly from other U.S. ethnoracial groups, reporting lower lifetime prevalence (6.7% v. 8.0-11.9%) and mean number (0.09 v. 0.11-0.18) of PLEs. In multivariate analyses, PLE clinical significance showed limited ethnoracial variation among Asian Americans, non-Caribbean Latinos, and Afro-Caribbeans. In other groups, mental health outcomes showed significant ethnoracial clustering by outcome (e.g. hospitalization and role interference with Caribbean-Latino origin), possibly due to underlying differences in psychiatric disorder chronicity or treatment barriers. CONCLUSIONS: While there is limited ethnoracial variation in U.S. PLE prevalence, PLE clinical significance varies across U.S. ethnoracial groups. Clinicians should consider this variation when assessing PLEs to avoid exaggerating their clinical significance, contributing to mental healthcare disparities.

Measuring Geographic "Hot Spots" of Racial/Ethnic Disparities: An Application to Mental Health Care.

This article identifies geographic "hot spots" of racial/ethnic disparities in mental health care access. Using data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys(CPES), we identified metropolitan statistical areas(MSAs) with the largest mental health care access disparities ("hot spots") as well as areas without disparities ("cold spots"). Racial/ethnic disparities were identified after adjustment for clinical need. Richmond, Virginia and Columbus, Georgia were found to be hot spots for Black-White disparities, regardless of method used. Fresno, California and Dallas, Texas were ranked as having the highest Latino-White disparities and Riverside, California and Houston, Texas consistently ranked high in Asian-White mental health care disparities across different methods. We recommend that institutions and government agencies in these "hot spot" areas work together to address key mechanisms underlying these disparities. We discuss the potential and limitations of these methods as tools for understanding health care disparities in other contexts.

Transnational ties and past-year major depressive episodes among Latino immigrants.

Latino immigrants live in an increasingly global world in which maintaining contact with kin in the home country is easier than ever. We examined (a) the annual distribution of remittances burden (percentage of remittances/household income) and visits to the home country, (b) the association of these transnational ties with a past-year major depressive episode (MDE), and (c) moderation by Latino subethnicity or gender. We conducted weighted logistic regression analyses with the Latino immigrant subsample (N = 1,614) of the National Latino and Asian American Study. Mexican and Other Latino immigrants had greater remittances burden than Puerto Rican migrants. Cuban immigrants made the fewest visits back home. After adjustment for sociodemographics and premigration psychiatric history, remittances burden decreased odds of MDE (odds ratio [OR] = 0.80, 95% confidence interval [CI] [0.67, .0.98]), whereas visits back home increased odds of MDE (OR = 1.04, 95% CI [1.01, 1.06]). Latino subethnicity was not a significant moderator. Visits back home were more strongly linked to depression among women than men. The distribution of transnational ties differs by Latino subgroup, although its association with depression is similar across groups. Monetary giving through remittances might promote a greater sense of self-efficacy, and caregiving for relatives back home that positively affect mental health. Visits back home, especially for women, might signal social stress from strained relationships with kin, spouses, or children left behind, or increased caregiving demands that negatively affect mental health. Clinical practice with immigrants should routinely assess the social resources and strains that fall outside national borders.

Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups.

OBJECTIVE: Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States. METHODS: The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference. RESULTS: Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge. CONCLUSIONS: Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Neighborhood characteristics and differential risk for depressive and anxiety disorders across racial/ethnic groups in the United States.

BACKGROUND: The prevalence of psychiatric disorders varies depending on the person's neighborhood context, their racial/ethnic group, and the specific diagnoses being examined. Less is known about specific neighborhood features that represent differential risk for depressive and anxiety disorders (DAD) across racial/ethnic groups in the United States. This study examines whether neighborhood etiologic factors are associated with DAD, above and beyond individual-level characteristics, and whether these associations are moderated by race/ethnicity. METHODS: We utilized nationally representative data (N = 13,837) from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file). Separate weighted multilevel logistic regression models were fitted for any past-year depressive and/or anxiety disorder, any depressive disorder only, and any anxiety disorder only. RESULTS: After adjusting for individual-level characteristics, African Americans living in a neighborhood with greater affluence and Afro-Caribbeans residing in more residentially unstable neighborhoods were at increased risk for any past-year depressive disorder as compared to their non-Latino white counterparts. Further, Latinos residing in neighborhoods with greater levels of Latino/immigrant concentration were at increased risk of any past-year anxiety disorder. Lastly, Asians living in neighborhoods with higher levels of economic disadvantage were at decreased risk of any past-year depressive and/or anxiety disorders compared to non-Latino whites, independent of individual-level factors. Differences across subethnic groups are also evident. CONCLUSIONS: Results suggest neighborhood characteristics operate differently on risk for DAD across racial/ethnic groups. Our findings have important implications for designing and targeting interventions to address DAD risk among racial/ethnic minorities.

The importance of family factors and generation status: mental health service use among Latino and Asian Americans.

The present study utilized data from the National Latino and Asian American Study to examine ethnic and generational differences in family cultural conflict and family cohesion and how the effects of such family conflict and cohesion on lifetime service use vary by generation status for Latino Americans (n = 2,554) and Asian Americans (n = 2,095). Findings revealed that first-generation Asian Americans reported greater family cultural conflict than their Latino counterparts, but third-generation Latino Americans had higher family conflict than their Asian American counterparts. First-generation Latino and Asian Americans had the highest levels of family cohesion. Results from logistic regression analyses indicated that Latino Americans who reported higher family cultural conflict and lower family cohesion were more likely to use mental health services. For Asian Americans, family cultural conflict, but not family cohesion, was associated with service use. Relative to third-generation Asian Americans, second-generation Asian Americans with higher family cultural conflict were more likely to use mental health services. Given that cohesive familial bonds appear to discourage service use on the part of Latino Americans irrespective of generation status, further research is needed to ascertain the extent to which this tendency stems from greater reliance on family support as opposed to the stigma associated with mental health treatment. Mental health providers and treatment programs need to address the role of family cultural conflict in the lives of Asian Americans, particularly second generation, and Latino Americans across generations, because conflictual family ties may motivate help-seeking behaviors and reveal substantial underlying distress.

Patient-clinician ethnic concordance and communication in mental health intake visits.

OBJECTIVE: This study examines how communication patterns vary across racial and ethnic patient-clinician dyads in mental health intake sessions and its relation to continuance in treatment, defined as attending the next scheduled appointment. METHODS: Observational study of communication patterns among ethnically/racially concordant and discordant patient-clinician dyads. Primary analysis included 93 patients with 38 clinicians in race/ethnic concordant and discordant dyads. Communication was coded using the Roter Interaction Analysis System (RIAS) and the Working Alliance Inventory Observer (WAI-O) bond scale; continuance in care was derived from chart reviews. RESULTS: Latino concordant dyad patients were more verbally dominant (p<.05), engaged in more patient-centered communication (p<.05) and scored higher on the (WAI-O) bond scale (all p<.05) than other groups. Latino patients had higher continuance rates than other patients in models that adjusted for non-communication variables. When communication, global affect, and therapeutic process variables were adjusted for, differences were reversed and white dyad patients had higher continuance in care rates than other dyad patients. CONCLUSION: Communication patterns seem to explain the role of ethnic concordance for continuance in care. PRACTICE IMPLICATIONS: Improve intercultural communication in cross cultural encounters appears significant for retaining minorities in care.

The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S.

Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area's organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.

Neighborhood context and substance use disorders: a comparative analysis of racial and ethnic groups in the United States.

BACKGROUND: There is evidence that ethnic/racial minorities are conferred differential risk for substance use problems based on where they live. Despite a burgeoning of research focusing on the role of neighborhood characteristics on health, limited findings are available on substance use. Our study uses nationally representative data (N=13,837) to examine: (1) what neighborhood characteristics are associated with risk of substance use disorders?; (2) do the associations between neighborhood characteristics and substance use disorders remain after adjusting for individual-level factors?; and (3) do neighborhood characteristics associated with substance use disorders differ by race/ethnicity after adjusting for individual-level factors? METHODS: Data were drawn from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file) with 836 census tracts. Analyses included African Americans, Asians, Caribbean Blacks, Latinos, and non-Latino whites. Separate logistic regression models were fitted for any past-year substance use disorder, alcohol use disorder, and drug use disorder. RESULTS: Living in more affluent and residentially unstable census tracts was associated with decreased risk of past-year substance use disorder, even after adjusting for individual-level factors. However, when we investigated the interaction of race/ethnicity and census latent factors with past-year substance use disorders, we found different associations for the different racial/ethnic groups. We also found different associations between neighborhood affluence, residential instability and any past-year substance use and alcohol disorders by nativity. CONCLUSIONS: Characteristics of the environment might represent differential risk for substance disorders depending on a person's ethnicity/race and nativity status.

Associations of physical symptoms with perceived need for and use of mental health services among Latino and Asian Americans.

Although many believe that low rates of perceived mental health need and service use among racial/ethnic minorities are due, in part, to somatization, data supporting this notion are lacking. This study examined two hypotheses: (1) increased physical symptoms are associated with lower perceived need for mental health services and actual service use; and (2) physical symptoms are most strongly associated with perceived mental health need and service use among first-generation individuals. Data come from the National Latino and Asian-American Study, a nationally-representative household survey in the United States conducted from 2002 to 2003. Participants reported on the presence of fourteen physical symptoms within the past year. Perceived mental health need was present for individuals who endorsed having an emotional or substance use problem or thinking they needed treatment for such a problem within the past year. After adjusting for sociodemographic and clinical covariates, the number of physical symptoms was positively associated with perceived mental health need and service, an effect that differed by generation. Among first-generation individuals, physical symptoms were associated with increased perceived need and service use. Physical symptoms were not significantly associated with perceived need or service use among third-generation Latinos, but were associated with service use among third-generation Asian-Americans. Physical symptoms do not appear to interfere with mental health problem recognition or service use. In contrast, individuals, especially of the first-generation, with more physical symptoms were more likely to perceive need for and utilize mental health services. Our findings do not support the notion that physical symptoms account for low rates of perceived mental health need and service use among Latino and Asian-Americans.

Unmet need for treatment for substance use disorders across race and ethnicity.

BACKGROUND: The objective was to analyze disparities in unmet need for substance use treatment and to observe variation across different definitions of need for treatment. METHODS: Data were analyzed from the 2002 to 2005 National Survey of Drug Use and Health and the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regressions estimated the likelihood of specialty substance use treatment across the two data sets. Parallel variables for specialty, informal and any substance abuse treatment were created. Perceived need and normative need for substance use treatment were defined, with normative need stratified across lifetime disorder, past twelve month disorder, and heavy alcohol/any illicit drug use. Treatment rates were analyzed, comparing Blacks, Asians and Latinos to non-Latino whites across need definitions, and adjusting for age, sex, household income, marital status, education and insurance. RESULTS: Asians with past year substance use disorder had a higher likelihood of unmet need for specialty treatment than whites. Blacks with past year disorder and with heavy drinking/illicit drug use had significantly lower likelihood of unmet need. Latinos with past year disorder had a higher likelihood of unmet need for specialty substance abuse treatment. Asians with heavy drinking/illicit drug use had lower likelihood of unmet need. CONCLUSIONS: The findings suggest that pathways to substance abuse treatment differ across groups. Given high rates of unmet need, a broad approach to defining need for treatment is warranted. Future research to disentangle social and systemic factors from factors based on diagnostic criteria is necessary in the identification of need for treatment.

The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services.

OBJECTIVE: To estimate whether racial/ethnic behavioral health service disparities are likely to be reduced through insurance expansion coverage expected through the Affordable Health Care Act. DATA SOURCES: Pooled data from the nationally representative NIMH Collaborative Psychiatric Epidemiological Studies (2001-2003). STUDY DESIGN: We employ a novel reweighting method to estimate service disparities in the presence and absence of insurance coverage. DATA COLLECTION: Access to care was assessed by whether any behavioral health treatment was received in the past year. Need was determined by presence of prior year psychiatric disorder, psychiatric diagnoses, physical comorbidities, gender, and age. PRINCIPAL FINDINGS: Improving patient education and availability of community clinics, combined with insurance coverage reduces service disparities across racial/ethnic groups.However, even with expanded insurance coverage, approximately 10 percent fewer African Americans with need for behavioral health services are likely to receive services compared to non-Latino whites while Latinos show no measurable disparity. CONCLUSIONS: Expansion of insurance coverage might have different effects for racial/ethnic groups, requiring additional interventions to reduce disparities for all groups.

Prevalence of physical symptoms and their association with race/ethnicity and acculturation in the United States.

OBJECTIVE: Physical symptoms are common and a leading reason for primary care visits; however, data are lacking on their prevalence among racial/ethnic minorities in the United States. This study aimed to compare the prevalence of physical symptoms among White, Latino and Asian Americans, and examine the association of symptoms and acculturation. METHODS: We analyzed data from the National Latino and Asian American Study, a nationally representative survey of 4864 White, Latino and Asian American adults. We compared the age- and gender-adjusted prevalence of 14 physical symptoms among the racial/ethnic groups and estimated the association between indicators of acculturation (English proficiency, nativity, generational status and proportion of lifetime in the United States) and symptoms among Latino and Asian Americans. RESULTS: After adjusting for age and gender, the mean number of symptoms was similar for Whites (1.00) and Latinos (0.95) but significantly lower among Asian Americans (0.60, P<.01 versus Whites). Similar percentages of Whites (15.4%) and Latinos (13.0%) reported three or more symptoms, whereas significantly fewer Asian Americans (7.7%, P<.05 versus Whites) did. In models adjusted for sociodemographic variables and clinical status (psychological distress, medical conditions and disability), acculturation was significantly associated with physical symptoms among both Latino and Asian Americans, such that the most acculturated individuals had the most physical symptoms. CONCLUSIONS: The prevalence of physical symptoms differs across racial/ethnic groups, with Asian Americans reporting fewer symptoms than Whites. Consistent with a "healthy immigrant" effect, increased acculturation was strongly associated with greater symptom burden among both Latino and Asian Americans.

Prevalence of neurasthenia, comorbidity, and association with impairment among a nationally representative sample of US adults.

PURPOSE: There are no current psychiatric epidemiological studies examining prevalence estimates of neurasthenia across different racial and ethnic groups in the US. This study compares prevalence rates of International Classification of Diseases (ICD-10) lifetime and 12-month neurasthenia across racial/ethnic groups in the US (Asians, African Americans, Latinos, and non-Latino Whites) and by levels of acculturation. We examine comorbidity of neurasthenia with DSM-IV psychiatric disorders and the association between neurasthenia and impairment. METHODS: We used a pooled sample (N = 10, 118) from two nationally representative household surveys of adults ages 18 years and older: the National Comorbidity Survey-Replication (NCS-R) and the National Latino and Asian American Study (NLAAS). RESULTS: Among the total sample, the adjusted prevalence rates of lifetime and 12-month neurasthenia with exclusionary criteria were 2.22 and 1.19%. The adjusted prevalence rates for lifetime and 12-month neurasthenia without exclusionary criteria were 4.89 and 2.80%. There were significant racial/ethnic group differences in prevalence for both lifetime and past-year neurasthenia, with Asians reporting significantly lower prevalence of neurasthenia than their non-Latino White counterparts. Less acculturated individuals were at a decreased risk for lifetime and past-year neurasthenia. Lifetime neurasthenia was associated with increased odds of meeting lifetime criteria for any depressive, any anxiety, and any substance use disorder. Respondents with lifetime or past-year neurasthenia had significantly greater levels of impairment compared to those without neurasthenia. CONCLUSION: Neurasthenia is a prevalent condition deserving further research attention given its comorbidity with other psychiatric disorders and its association with functional impairment.

Racial/ethnic differences in video game and Internet use among US adolescents with mental health and educational difficulties.

Video game and Internet use can be associated with poor mental health and educational outcomes among adolescents. Racial/ethnic minority youth use these media more than White youth. Video game and Internet use among adolescents with mental health and educational difficulties may therefore differ by race/ethnicity in clinically meaningful ways. We analyzed a representative sample of 8th grade students in the United States from the Early Childhood Longitudinal Survey-Kindergarten (N=6,700). Stratifying by gender, we assessed racial/ethnic differences in the associations between video game and Internet use, mental health, and reading and math achievement. Significant minority-White differences were identified in associations between media use and mental health and educational achievement. Video game use was relatively high among black females with prior mental health diagnoses and Asian-American males with high internalizing symptoms. Understanding video game and Internet use among racial/ethnic minority youth with mental health and educational difficulties may improve clinical practice.

The prevalence and comorbidity of social anxiety disorder among United States Latinos: a retrospective analysis of data from 2 national surveys.

OBJECTIVE: Social anxiety disorder (SAD) is increasingly being recognized as a prevalent, unremitting, and highly comorbid disorder, yet studies focusing on this disorder among US Latinos and immigrant populations are not available. This article evaluates ethnic differences in the prevalence and comorbidity of SAD as well as the clinical and demographic characteristics associated with SAD. Cultural and contextual factors associated with risk of SAD are also examined within the Latino population more specifically. METHOD: Data are analyzed from the National Latino and Asian American Study and the National Comorbidity Survey-Replication. Both studies utilized the World Health Organization-Composite International Diagnostic Interview, which estimates the prevalence of lifetime and 12-month psychiatric disorders according to DSM-IV criteria. RESULTS: Latinos reported a lower lifetime and 12-month SAD prevalence and a later age at onset than US-born non-Latino whites. On the other hand, Latinos diagnosed with 12-month SAD reported higher impairment across home, work, and relationship domains than their non-Latino white counterparts. Relative to non-Latino whites, Latinos who entered the United States after the age of 21 years were less likely to have lifetime SAD comorbidity with drug abuse and dependence and more likely to report lifetime SAD comorbidity with agoraphobia. CONCLUSIONS: The pattern of risk and associated characteristics of SAD varies for Latinos as compared to non-Latino whites. This is reflected by differences between these 2 groups across SAD prevalence, onset, impairment, and comorbidity. The particularly high comorbidity found with agoraphobia among Latinos who arrive in the United States as adults suggests that cultural factors and timing of immigration play a role in the manifestation and course of anxiety disorders. Interventions designed to decrease the levels of impairment associated with SAD are needed as well as efforts to target Latinos suffering from this disorder, specifically.

Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders.

OBJECTIVE: The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non-Latino Whites. METHOD: Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used. RESULTS: The prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non-Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non-Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non-Latino Whites for respondents with a lifetime history of any eating disorder. DISCUSSION: These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States.

The relationship between obesity and psychiatric disorders across ethnic and racial minority groups in the United States.

CONTEXT: Epidemiologic studies of obesity have not examined the prevalence and relationship of mental health conditions with obesity for diverse ethnic and racial populations in the United States. OBJECTIVE: (1) To assess whether obesity was associated with diverse psychiatric diagnoses across a representative sample of non-Latino whites, Latinos, Asians, African-Americans, and Afro-Caribbeans; and (2) to test whether physical health status, smoking, sociodemographic characteristics, and psychiatric comorbidities mediate any of the observed associations. DESIGN: Our analyses used pooled data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES). Analyses tested the association between obesity and psychiatric disorders in a diverse sample of Americans (N=13,837), while adjusting for factors such as other disorders, age, gender, socioeconomic status, smoking and physical health status (as measured by chronic conditions and WHO-DAS scores) in different models. RESULTS: The relationship between obesity and last-year psychiatric disorders varied by ethnicity/race. The likelihood of having mood or anxiety disorder was positively associated with obesity for certain racial/ethnic groups, but was moderated by differences in physical health status. Substance-use disorders were associated with decreased odds for obesity in African-Americans. CONCLUSIONS: The role of physical health status (as measured by chronic conditions and WHO-DAS scores) dramatically changes the pattern of associations between obesity and psychiatric disorders, suggesting the important role it plays in explaining differential patterns of association across racial and ethnic groups.

English language proficiency and mental health service use among Latino and Asian Americans with mental disorders.

OBJECTIVE: The impact of language proficiency as a potential contributor to ethnic disparities in mental health care has received less attention than other factors. Data from the National Latino and Asian American Study were examined to assess the impact of limited English proficiency (LEP) on access to and quality of mental health care for community-dwelling Latino and Asian Americans with mental disorders. METHODS: English-proficient (EP) and LEP individuals with mental disorders were compared on lifetime use of healthcare services for a mental disorder, duration of untreated disorders, receipt of minimally adequate care, and barriers to treatment (eg, lack of identification of need for treatment, language barriers, and embarrassment or discomfort related to treatment). RESULTS: Compared with EP individuals, LEP individuals with mental disorders were significantly less likely to identify a need for mental health services, experience longer duration of untreated disorders, and use fewer healthcare services for mental disorders, particularly specialty mental health care. Receipt of minimally adequate care did not differ significantly by language proficiency. Embarrassment and discomfort were not more common among LEP individuals. Perceived need for treatment predicted lifetime mental healthcare use, whereas embarrassment and discomfort did not. CONCLUSIONS: Among Latino and Asian Americans with mental disorders, LEP contributes to disparities in access to care and longer duration of untreated disorders. Potential disparities in quality of care were difficult to detect in the context of low overall rates of mental healthcare use and quality of care among both LEP and EP individuals.