Dissertation Title:  "Examining Changes in Mental Health Care by Race/Ethnicity: 1990-1992 to 2001-2003"

Using data from the 1990-1992 National Comorbidity Survey (Time 1) and the 2001-2003 National Comorbidity Survey – Replication (Time 2), this dissertation examines changes in mental health care among individuals with a 12-month mood and/or anxiety disorder by race/ethnicity. Paper 1 assesses trends in White-Black and White-Latino disparities in the use of any mental health care and minimally adequate mental health care. Disparities in the use of any mental health care increased over time, particularly between Whites and Blacks in the general medical (GM) sector and between Whites and Latinos in the specialty mental health sector (SMH) sector. Disparities in the use of minimally adequate mental health care persisted between Whites and Blacks over time, but were not detected between Whites and Latinos in either time period.

Paper 2 examines the role socioeconomic status (SES) plays in changes in White-Black and White-Latino disparities in mental health care. The Institute of Medicine definition of racial/ethnic disparities recognizes the contributing effect of SES to racial/ethnic disparities in health care. Using two different sets of analyses, one where we control for SES and one where we do not, we found that controlling for SES did not influence racial/ethnic disparity estimates at both time periods, nor did it influence how these disparities changed over time.

Paper 3 examines whether racial/ethnic differences in perceived need and perceived barriers to mental health care help explain White-Black and White-Latino disparities in the use of mental health care. In Time 1, Blacks and Latinos were similar to Whites in perceiving a need for mental health care. Among those with perceived need at Time 1, no disparities in the use of care existed. In Time 2, Blacks and Latinos were once again similar to Whites in perceiving need. However at Time 2, racial/ethnic disparities in the use of mental health care emerged among those with perceived need. Among those with perceived need who did not receive care, Blacks and Latinos were more similar to Whites than they were dissimilar in endorsing a perceived barrier to care, with only a few exceptions in either time period.