Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes

Area of Science:

• Clinical Psychology and Health Services Research
• Mental Health Disparities
• Psychotherapy Utilization and Effectiveness

Background:

• Psychotherapy access, utilization, retention, and effectiveness require improvement, particularly for ethnoracial minorities.
• Intersectionality of ethnoracial status with other demographics may create structural barriers and impact care effectiveness.
• Further research is needed to understand these disparities and improve equitable mental health care.

Purpose of the Study:

• To examine psychotherapy access, utilization, retention, and effectiveness across diverse ethnoracial groups.
• To investigate the role of intersectionality (e.g., ethnoracial status and gender) in mental health care.
• To identify disparities in mental health service delivery and outcomes.

Main Methods:

• Analysis of routinely collected clinical data from 2,076 clients at a low-cost university psychology clinic.
• Inclusion of client demographics, intake severity, session attendance, no-shows, and premature termination data.
• Utilized chi-square tests, ANOVA, and ANCOVA to analyze treatment utilization gaps and effectiveness differences.

Main Results:

• Lower outreach and suboptimal retention rates were observed for Black clients compared to community prevalence.
• Few differences in psychotherapy outcomes were found across ethnoracial status, gender, or their intersection once engaged.
• Ethnoracial matching was associated with increased session attendance among Black clients.

Conclusions:

• Psychotherapy effectiveness can be optimized for all populations.
• Cultural formulation interviews and cultural humility are promising approaches to improve care.
• Addressing disparities in access and retention is crucial for equitable mental health outcomes.