Impact of lifetime evaluated need on mental health service use among African American emerging adults.

OBJECTIVE: This study investigated the association between evaluated need and mental health service use among African-American emerging adults, when controlling for other predictor variables. METHOD: Secondary analysis of data from the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African-American emerging adults, ages 18 to 29 years (N = 806), was assessed with the Composite International Diagnostic Interview. The sample included females and males with a mean age of 23 years. Evaluated need was determined by endorsement of mood, anxiety, substance use, or impulse control diagnoses. Respondents who reported ever voluntarily using mental health or general medical services to address these problems were considered to have used services. RESULTS: Forty-seven percent of the sample demonstrated an evaluated need for services, whereas a quarter of the sample used services in their lifetime. Respondents who were females, had received religious/spiritual support, and who had an evaluated need for services were significantly more likely to have used services in their lifetime compared with males, those who had not received religious/spiritual support, and those without a need for services. CONCLUSIONS: Literature indicates that evaluated need is a strong predictor of mental health service use, yet research examining its impact on service use among African American emerging adults is limited. This study found that along with having an evaluated need, this population was more likely to use services when supported by a religious/spiritual leader. Mental health outreach and education that incorporates the informal support systems identified by African American emerging adults, particularly males, is needed.

Retaining Low-Income Minority Cancer Patients in a Depression Treatment Intervention Trial: Lessons Learned.

Previously published work finds significant benefit from medical and behavioral health team care among safety-net patients with major depression. This qualitative study assessed clinical social worker, psychiatrist and patient navigator strategies to increase depression treatment among low-income minority cancer patients participating in the ADAPt-C clinical depression trial. Patient care retention strategies were elicited through in-depth, semi-structured interviews with nine behavioral health providers. Using grounded theory, concepts from the literature and dropout barriers identified by patients, guided interview prompts. Retention strategies clustered around five dropout barriers: (1) informational, (2) instrumental, (3) provider-patient therapeutic alliance, (4) clinic setting, and (5) depression treatment. All strategies emphasized the importance of communication between providers and patients. Findings suggest that strong therapeutic alliance and telephone facilitates collaborative team provider communication and depression treatment retention among patients in safety-net oncology care systems.

Mental health service use among African-American emerging adults, by provider type and recency of use.

OBJECTIVE: This study examined factors associated with mental health service utilization among African-American emerging adults, specifically, when services were used (recency) and the types of providers visited (mental health versus non-mental health). METHODS: Guided by the behavioral model for vulnerable populations, secondary analysis of responses to the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African-American emerging adults, ages 18-29 (N=806), were assessed with the Composite International Diagnostic Interview. "Evaluated need" was determined by endorsement of mood, anxiety, substance use, or impulse control diagnoses. Respondents who reported a need for services for emotional or substance use problems were considered to have a "perceived need." Those who reported voluntary use of mental health or general medical services to address these problems were considered to have utilized services. RESULTS: Twenty-five percent of the sample utilized services in their lifetime, whereas 9% utilized services in the past 12 months. Females were more likely than males to utilize services in three of the four service use categories (lifetime, mental health sector, and non-mental health sector). Respondents with an evaluated need for services were two to 12 times more likely to have used services compared with those without a need for them. CONCLUSIONS: Little is known about why African-American emerging adults underutilize mental health services. Being female and having an evaluated need for services were associated with greater odds of service use, which would suggest the need for additional examination of gender differences in service utilization and greater mental health outreach and education among African-American males.