Skip to main content
Log in

Frequency and Scope of Mental Health Service Delivery to African Americans in Primary Care

  • Published:
Mental Health Services Research

Abstract

This study examines whether African Americans with mental health complaints visit primary care physicians more than psychiatrists, and whether they demonstrate this preference more than do Whites. It addresses also whether when presenting with mental health concerns, African Americans and Whites receive a comparable range of interventions, including psychotropic medications. National estimates using the National Ambulatory Medical Care Surveys conducted in 1995 and 1996 confirmed the first hypothesis: African American did make more mental health-related office visits to primary care physicians than did psychiatrists and they did so more than Whites. Mental health interventions on behalf of African Americans and Whites proved to be similar, except that African Americans were less likely to be provided a psychotropic medication. Because African Americans are especially likely to receive outpatient mental health services from primary care physicians, the lower quality of mental health care occurring in primary care disproportionately affects African Americans. Fewer African American visits resulted in prescribing psychotropic medications, and this corroborated findings by other researchers. More research is needed to understand this disparity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Alegria, M., Canino, G., Rios, R., & Vera, M. (2000). Inequalities in rates of mental health service use among Latinos, African Americans, and non-Latino whites in the U.S. Paper presented at Disparities in Mental Health Care for Latinos, University of California, Los Angeles, CA.

    Google Scholar 

  • American Medical Association. (1995). ICD-9-CM: International classification of diseases, clinical modification (9th Rev). Chicago: Author.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Bach, P. B., Cramer, L. D., Waren, J. L., & Begg, C. B. (1999). Racial differences in the treatment of early-stage lung cancer. New England Journal of Medicine, 341, 1198-1205.

    Google Scholar 

  • Balzer, D.G., Hybels, C. F., Simonsick, E. M., & Hanlon, J. T. (2000). Marked differences in antidepressant use by race in an elderly community sample: 1986-1996. American Journal of Psychiatry, 157, 1089-1094.

    Google Scholar 

  • Brown, C., Schulberg, H. C., & Madonia, M. J. (1996). Clinical presentation of major depression by African Americans and Whites in primary care practice. Journal of Affective Disorders, 41, 181-191.

    Google Scholar 

  • Brown, C., Schulberg, H. C., Saco, D., Perel, J. M., & Houck, P. R. (1999). Effectiveness of treatments for major depression in primary medical care practice:Apost hoc analysis of outcomes for African American and White patients. Journal of Affective Disorders, 53, 185-192.

    Google Scholar 

  • Christie-Seely, J. (1984). Working with families in primary care.New York: Praeger.

    Google Scholar 

  • Cleary, P. (1989). The need and demand for mental health services. In C. Taube, D. Mechanic, & A. Hohmann (Eds.), The future of mental health services research (pp. 161-183). Washington, DC: Department of Health and Human Services.

    Google Scholar 

  • Cooper-Patrick, L., Gallo, J. J., Powe, N. R., Steinwachs, D. M., Eaton, W. W., & Ford, D. E. (1999). Mental health service utilization by African Americans and whites: The Baltimore Epidemiologic Catchment Area Follow-Up. Medical Care, 37, 1034-1045.

    Google Scholar 

  • Cooper-Patrick, L., Powe, N. R., Jenckes, M. W., Gonzales, J. J., Levine, D. M., & Ford, D. E. (1997). Identification of patient attitudes and preferences regarding treatment of depression. Journal of General Internal Medicine, 12, 431-438.

    Google Scholar 

  • Cunningham, P. J., & Freiman, M. P. (1996). Determinants of ambulatory mental health service use for school-age children and adolescents. Mental Health Services Research, 31, 409-427.

    Google Scholar 

  • Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. (2000). Understanding disability in mental and general medical conditions. Journal of General Internal Medicine, 15, 527-534.

    Google Scholar 

  • Gibelman, K., & Schervish, P. (Eds.). (1997). Who we are. Washington, DC: National Association of SocialWorkers.

    Google Scholar 

  • Katon, W., & Schulberg, H. (1992). Epidemiology of depression in primary care. General and Hospital Psychiatry, 14, 237-247.

    Google Scholar 

  • Kroenke, K., Taylor-Vaisey, A., Dietrich, A. J., & Oxman, T. E. (2000). Interventions to improve provider diagnosis and treatment of mental disorders in primary care: A Critical review of the literature. Psychosomatics, 41, 39-52.

    Google Scholar 

  • Lehman, A. F., & Steinwachs, D. M. (1998). Patterns of usual care for schizophrenia: Initial results from the schizophrenia patient outcome research team (PORT) client survey. Schizophrenia Bulletin, 24, 11-20.

    Google Scholar 

  • Marrow, W., Reiger, D. A., Rae, D. S., Manderschied, R. W., & Locke, B. Z. (1993). Use of services by persons with mental and addictive disorders: Findings from the NIMH epidemiological catchment area study. Archives of General Psychiatry, 50, 95-107.

    Google Scholar 

  • Melfi, C. A., Croghan, T. W., Hanna, M. P., & Robinson, R. L. (2000). Racial variation in antidepressant treatment in a Medicaid population. Journal of Clinical Psychiatry, 61, 16-21.

    Google Scholar 

  • Mukamel, D. B., Murphy, A. S., & Weiner, D. L. (2000). Racial differences in access to high-quality cardiac surgeons. American Journal of Public Health, 90, 1774-1777.

    Google Scholar 

  • National Center for Health Statisics. (1996). Ambulatory Medical Care Survey 1995 and 1996, Proprietary Use Data Sets. Hyattsville, MD: Research Data Center, National Center for Health Statistics.

    Google Scholar 

  • National Center for Health Statistics. (1999). Healthy people 2000 review: 1998-99. Hyattsville, MD: Author.

    Google Scholar 

  • Olfson, M., & Pincus, H. A. (1996). Outpatient mental health care in nonhospital settings: Distribution of patients across provider groups. American Journal of Psychiatry, 153, 1353-1356.

    Google Scholar 

  • Pasko, T., & Seidman, B. (1999). Physician characteristics and distribution in the US: 1999 edition. Chicago: American Medical Association.

    Google Scholar 

  • Pederson, P., & Sartorius, N. (Eds.). (1984). Mental health services: The cross-cultural context. Beverly Hills, CA: Sage.

    Google Scholar 

  • Pincus, H. A., Tanielian, M. A., Marcus, S. C., Olfson, M., Zarin, D. A., Thompson, J., et al. (1998). Prescribing trends in psychotropic medications. JAMA, 279, 526-531.

    Google Scholar 

  • Robins, L., & Regier, D. (1991). Psychiatric disorders in America. New York: Free Press.

    Google Scholar 

  • Roetzheim, R. G., Pal, N., Gonzalez, E. C., Ferrante, J. M., Van Durme, D. J., & Krischer, J. P. (2000). Effects of health insurance and race on colorectal cancer treatments and outcomes. American Journal of Public Health, 90, 1746-1754.

    Google Scholar 

  • Schappert, S. (1996). National Ambulatory Medical Care Survey. 1996 Summary: Advance data from vital and health statistics. Hyattsville, MD: National Center for Health Statistics.

    Google Scholar 

  • Schulberg, H. C. (1991). Mental disorders in the primary care setting. General and Hospital Psychiatry, 13, 156-164.

    Google Scholar 

  • Selby, J., Grumbach, K., Quesenberry, C. P., Jr., Schmittdiel, J. A.,& Truman, A. F. (1999). Differences in resource use and costs of primary care in a large HMO according to physician specialty. Health Services Research, 34, 503-518.

    Google Scholar 

  • Sleath, B., Svarstad, B., & Roter, D. (1998). Patient and psychotropic prescribing during medical encounters. Patient Education Counseling, 24, 227-238.

    Google Scholar 

  • Snowden, L. R. (1999). African American service use for mental health problems. Journal of Community Psychology, 27, 303-313.

    Google Scholar 

  • Snowden, L. R. (2001). Barriers to providing effective mental health services to African Americans. Mental Health Services Research, 3, 181-188.

    Google Scholar 

  • Stata Corporation. (1997). STATA Statistical Software (6.0 edn.). College Station, TX: Stata Press.

    Google Scholar 

  • U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity-A supplement to mental health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration, Center for Mental Health Services.

    Google Scholar 

  • Volk, R. J., Nease, D. E., & Cass, A. R. (1997). Recognition of mental health problems in primary care practices. Family Medicine, 29, 182-183.

    Google Scholar 

  • Wang, P. S., Berglund, P., & Kessler, R. C. (2000). Recent care of common mental disorders in the United States. Journal General Internal Medicine, 15, 284-192.

    Google Scholar 

  • Wells, K. B., Hays, R. D., Burnam, M. A., Rogers, W., Greenfield, S., & Ware, J. E. (1989). Detection of depressive disorder for patients receiving prepaid or fee-for-service care. JAMA, 262, 3298-3302.

    Google Scholar 

  • Wells, K. B., Sturm, R., Sherbourne, C. D., & Meredith, L. S. (1996). Caring for Depression. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Williams, J. W., Rost, K., Dietrich, A. J., Ciotti, M. C., Zyanski, S. S. J., & Cornell, J. (1999). Primary care physicians' approach to depressive disorders. Archives of Family Medicine, 8, 58-67.

    Google Scholar 

  • Zarin, D. A., Pincus, H. A., Peterson, B. D., West, J. C., Suarez, A., Marcus, S. J., et al. (1998). Characterizing psychiatry with findings from the 1996 National Survey of Psychiatric Practice. American Journal of Psychiatry, 155, 397-404.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lonnie R. Snowden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Snowden, L.R., Pingitore, D. Frequency and Scope of Mental Health Service Delivery to African Americans in Primary Care. Ment Health Serv Res 4, 123–130 (2002). https://doi.org/10.1023/A:1019709728333

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1019709728333

Navigation