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Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health
Karen J Coleman1, Christine Stewart1, Beth E Waitzfelder1
1Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail: karen.j.coleman@kp.org ). Dr. Stewart and Dr. Simon are with the Group Health Research Institute, Group Health Cooperative, Seattle. Dr. Waitzfelder and Dr. Trinacty are with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Zeber and Dr. Copeland are with Health Services Research and Development, U.S. Department of Veterans Affairs, Temple, Texas, and the Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas. Dr. Morales is with the Center for Health Equity, Diversity and Inclusion, University of Washington, Seattle. Dr. Ahmed is with Kaiser Permanente Northern California, Permanente Medical Group, San Francisco. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit. Dr. Beck is with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Cummings is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland. Dr. Lindberg and Dr. Lynch are with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Dr. Owen-Smith is with the School of Public Health, Georgia State University, Atlanta. Dr. Whitebird is with the School of Social Work, University of St. Thomas/St. Catherine University, St. Paul, Minnesota.
Objective:
The objective of this study was to characterize racial-ethnic variation in diagnoses and treatment of mental disorders in large not-for-profit health care systems.
Methods:
Participating systems were 11 private, not-for-profit health care organizations constituting the Mental Health Research Network, with a combined 7,523,956 patients age 18 or older who received care during 2011. Rates of diagnoses, prescription of psychotropic medications, and total formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all health care settings.
Results:
Of the 7.5 million patients in the study, 1.2 million (15.6%) received a psychiatric diagnosis in 2011. This varied significantly by race-ethnicity, with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a psychiatric diagnosis, 73% (N=850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial-ethnic groups (odds ratio [OR] range .48-.81) to receive medication. In contrast, only 34% of patients with a psychiatric diagnosis (N=548,837) received formal psychotherapy. Racial-ethnic differences were most pronounced for depression and schizophrenia; compared with whites, non-Hispanic blacks were more likely to receive formal psychotherapy for their depression (OR=1.20) or for their schizophrenia (OR=2.64).
Conclusions:
There were significant racial-ethnic differences in diagnosis and treatment of psychiatric conditions across 11 U.S. health care systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.
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