Margarita Alegría

Prevalence of Mental Illness in Immigrant and Non-Immigrant U.S. Latino Groups

OBJECTIVE Although widely reported among Latino populations, contradictory evidence exists regarding the generalizability of the immigrant paradox, i.e., that foreign nativity protects against psychiatric disorders. The authors examined whether this paradox applies to all Latino groups by comparing estimates of lifetime psychiatric disorders among immigrant Latino subjects, U.S-born Latino subjects, and non-Latino white subjects. METHOD The authors combined and examined data from the National Latino and Asian American Study and the National Comorbidity Survey Replication, two of the largest nationally representative samples of psychiatric information. RESULTS In the aggregate, risk of most psychiatric disorders was lower for Latino subjects than for non-Latino white subjects. Consistent with the immigrant paradox, U.S.-born Latino subjects reported higher rates for most psychiatric disorders than Latino immigrants. However, rates varied when data were stratified by nativity and disorder and adjusted for demographic and socioeconomic differences across groups. The immigrant paradox consistently held for Mexican subjects across mood, anxiety, and substance disorders, while it was only evident among Cuban and other Latino subjects for substance disorders. No differences were found in lifetime prevalence rates between migrant and U.S.-born Puerto Rican subjects. CONCLUSIONS Caution should be exercised in generalizing the immigrant paradox to all Latino groups and for all psychiatric disorders. Aggregating Latino subjects into a single group masks significant variability in lifetime risk of psychiatric disorders, with some subgroups, such as Puerto Rican subjects, suffering from psychiatric disorders at rates comparable to non-Latino white subjects. Our findings thus suggest that immigrants benefit from a protective context in their country of origin, possibly inoculating them against risk for substance disorders, particularly if they emigrated to the United States as adults.

Mental Health Service Use in the Community and Schools: Results from the Four-Community MECA Study

ABSTRACT Objective To describe the use of mental health and substance abuse services by children and adolescents as reported from the four community sites included in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Method As part of the MECA survey, questions were developed to identify children and adolescents utilizing mental health and substance abuse services. Youths aged 9 through 17 years and a parent/ caretaker were interviewed. Because the investigators had concerns about the capacities of the younger children in the study to describe their use of mental health services, more extensive questions were asked of parents than of youths. Results The procedures developed by the MECA project identified patterns of service use that varied in the four communities surveyed. Agreement between reports of parents and youths regarding the use of mental health and substance abuse services showed substantial Inconsistencies, similar to reports of psychiatric disorders. At three of the four sites, the majority of children meeting criteria for a psychiatric disorder and scoring 60 or less on the Childrens Global Assessment Scale reported some mental health–related service in the previous year, although at two of the sites fewer than 25% of these youths were seen in the mental health specialty sector. Conclusion Community surveys show great promise for monitoring the need for mental health and substance abuse services and for identifying patterns of use.

Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States

OBJECTIVE Prior research on racial and ethnic disparities in depression treatment has been limited by the scarcity of national samples that include an array of diagnostic and quality indicators and substantial numbers of non-English-speaking individuals from minority groups. Using nationally representative data for 8,762 persons, the authors evaluated differences in access to and quality of depression treatments between patients in racial-ethnic minority groups and non-Latino white patients. METHODS Access to mental health care was assessed by past-year receipt of any mental health treatment. Adequate treatment for acute depression was defined as four or more specialty or general health provider visits in the past year plus antidepressant use for 30 days or more or eight or more specialty mental health provider visits lasting at least 30 minutes, with no antidepressant use. RESULTS For persons with past-year depressive disorder, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans, compared with 40.2% of non-Latino whites, did not access any past-year mental health treatment (significantly different at p<.001). Disparities in the likelihood of both having access to and receiving adequate care for depression were significantly different for Asians and African Americans in contrast to non-Latino whites. CONCLUSIONS Simply relying on present health care systems without consideration of the unique barriers to quality care that ethnic and racial minority populations face is unlikely to affect the pattern of disparities observed. Populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care.

Prevalence of Psychiatric Disorders Across Latino Subgroups in the United States

OBJECTIVES We examined the prevalence of depressive, anxiety, and substance use disorders among Latinos residing in the United States. METHODS We used data from the National Latino and Asian American Study, which included a nationally representative sample of Latinos. We calculated weighted prevalence rates of lifetime and past-year psychiatric disorders across different sociodemographic, ethnic, and immigration groups. RESULTS Lifetime psychiatric disorder prevalence estimates were 28.1% for men and 30.2% for women. Puerto Ricans had the highest overall prevalence rate among the Latino ethnic groups assessed. Increased rates of psychiatric disorders were observed among US-born, English-language-proficient, and third-generation Latinos. CONCLUSIONS Our results provide important information about potential correlates of psychiatric problems among Latinos that can inform clinical practice and guide program development. Stressors associated with cultural transmutation may exert particular pressure on Latino men. Continued attention to environmental influences, especially among third-generation Latinos, is an important area for substance abuse program development.

Use of Mental Health–Related Services Among Immigrant and US-Born Asian Americans: Results From the National Latino and Asian American Study

OBJECTIVES We examined rates of mental health-related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors. METHODS Data were derived from the National Latino and Asian American Study (2002-2003). RESULTS About 8.6% of the total sample (n=2095) sought any mental health-related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months. CONCLUSIONS Asian Americans demonstrated lower rates of any type of mental health-related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

Immigration-related factors and mental disorders among Asian Americans.

OBJECTIVES We examined lifetime and 12-month rates of any depressive, anxiety, and substance abuse disorders in a national sample of Asian Americans. We focused on factors related to nativity and immigration as possible correlates of mental disorders. METHODS Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of Asian Americans in the United States. RESULTS The relationships between immigration-related factors and mental disorders were different for men and women. Among women, nativity was strongly associated with lifetime disorders, with immigrant women having lower rates of most disorders compared with US-born women. Conversely, English proficiency was associated with mental disorders for Asian men. Asian men who spoke English proficiently generally had lower rates of lifetime and 12-month disorders compared with nonproficient speakers. CONCLUSIONS For Asian Americans, immigration-related factors were associated with mental disorders, but in different ways for men and women. Future studies will need to examine gender as an important factor in specifying the association between immigration and mental health.

Depressive and Disruptive Disorders and Mental Health Service Utilization in Children and Adolescents

OBJECTIVE To examine the relationship of depressive and disruptive disorders with patterns of mental health services utilization in a community sample of children and adolescents. METHOD Data were from the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The sample consisted of 1,285 child (ages 9-17 years) and parent/guardian pairs. Data included child psychopathology (assessed by the Diagnostic Interview Schedule for Children), impairment, child need and use of mental health services, and family socioeconomic status. RESULTS After adjusting for potential confounding factors, disruptive disorder was significantly associated with childrens use of mental health services, but depressive disorder was not. For school-based services, no difference was found between the 2 types of disorders. Parents perceived greater need for mental health services for children with disruptive disorders than for those with depression. Conversely, depression was more related to childrens perception of mental health service need than was disruptive disorder. CONCLUSIONS The findings highlight the need for more effective ways to identify and refer depressed children to mental health professionals, the importance of improving school-based services to meet childrens needs, and the necessity to better educate parents and teachers regarding the identification of psychiatric disorders, especially depression.

Correlates of Past-Year Mental Health Service Use Among Latinos: Results From the National Latino and Asian American Study

OBJECTIVES We examined correlates and rates of past-year mental health service use in a national sample of Latinos residing in the United States. METHODS We used data from the National Latino and Asian American Study, a national epidemiological household survey of Latinos. RESULTS Cultural factors such as nativity, language, age at migration, years of residence in the United States, and generational status were associated with whether or not Latinos had used mental health services. However, when the analysis was stratified according to past-year psychiatric diagnoses, these associations held only among those who did not fulfill criteria for any of the psychiatric disorders assessed. Rates of mental health service use among those who did not fulfill diagnostic criteria were higher among Puerto Ricans and US-born Latinos than among non-Puerto Ricans and foreign-born Latinos. CONCLUSIONS Rates of mental health service use among Latinos appear to have increased substantially over the past decade relative to rates reported in the 1990s. Cultural and immigration characteristics should be considered in matching mental health services to Latinos who need preventive services or who are symptomatic but do not fulfill psychiatric disorder criteria.

Correlates of unmet need for mental health services by children and adolescents

BACKGROUND Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents. METHODS Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months. RESULTS Of the total sample, 17.1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parents will. No youth-reported access barriers were significantly associated with unmet need. CONCLUSIONS The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.

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.