Skip to main content Accessibility help

Filters on the pathway to mental health care, II. Sociodemographic factors

  • J. J. Gallo (a1), S. Marino (a1), D. Ford (a1) and J. C. Anthony (a1)


This study uses the prospectively gathered data of the Epidemiologic Catchment Area Program, a multi-site interview survey of mental disturbances among adult household residents in the United States, to compare health services use by individuals with different sociodemographic characteristics, accounting for the first-time occurrence of psychiatric disorder, over the course of a 1-year follow-up interval. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. In the present investigation, 13400 continuing participants in the household sample who reported no contact with mental health services in the 6 months prior to the initial interview were studied with regard to health services use and sociodemographic characteristics. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. African-Americans were significantly less likely than whites to have consulted with a specialist in mental health (estimated relative odds, 0·22, 95% confidence interval 0·10 to 0·52), even accounting for coincident psychiatric disorder, gender, and other covariates known to be associated with differential use of health care services. Hispanics and other minorities were also less likely to have consulted a specialist in mental health (estimated relative odds, 0·37 and 0·26, respectively). This large community study extends previous work on mental health services and ethnicity.


Corresponding author

1Address for correspondence: Dr Joseph J. Gallo. Department of Mental Hygiene, The Johns Hopkins University School of Hygiene and Public Health, 624 North Broadway, Baltimore, Maryland 21205, USA.


Hide All
American Psychiatric Association, Committee on Nomenclature and Statistics (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.
American Medical Association Council on Scientific Affairs (1991). Hispanic health in the United States. Journal of the American Medical Association 265, 248252.
Anthony, J. C., Folstein, M., Romanoski, A. J., Von Korff, M. R., Nestadt, G. R., Chahal, R., Merchant, A., Brown, H., Shapiro, S., Kramer, M. & Gruenberg, E. M. (1985). Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis: experience in eastern Baltimore. Archives of General Psychiatry 42, 667675.
Armstrong, H. E., Ishiki, D., Heiman, J., Mundt, J. & Womack, W. (1984). Service utilization by black and white clientele in an urban community mental health center: revised assessment of an old problem. Community Mental Health Journal 20, 269281.
Broman, C. J. (1987). Race differences in professional help seeking. American Journal of Community Psychology 15, 473489.
Cooper, R. & David, R. (1986). The biological concept of race and its application to public health and epidemiology. Journal of Health Politics, Policy and Law 11, 97116.
Coulton, C. & Frost, A. K. (1982). Use of social and health services by the elderly. Journal of Health and Social Behavior 23, 330339.
Eaton, W. & Kessler, L. G. (1985). Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Academic Press, Inc.: New York.
Eaton, W. W., Anthony, J. C., Tepper, S. & Dryman, A. (1992). Psychopathology and attrition in the Epidemiologic Catchment Area surveys. American Journal of Epidemiology 135, 10511059.
Escobar, J. I., Rubio-Stipec, M., Canino, G. & Karno, M. (1989). Somatic Symptom Index (SSI): a new and abridged somatization construct: prevalence and epidemiologic correlates in two large community samples. Journal of Nervous and Mental Disease 177, 140146.
Escobar, J. I., Gomez, J. & Tuason, V. B. (1983). Depressive symptomatology in North and South American patients. American Journal of Psychiatry 140, 4751.
German, P. S., Shapiro, S. & Skinner, E. A. (1985) Mental health of the elderly: use of health and mental health services. Journal of the American Geriatrics Society 33, 246252.
German, P. S., Shapiro, S., Skinner, E. A., Von Korff, M., Klein, L. E., Turner, R. W., Teitelbaum, M. L., Burke, J. & Burns, B. J. (1987). Detection and management of mental health problems of older patients by primary care providers. Journal of the American Medical Association 257, 489493.
Ginzberg, E. (1991). Access to health care for Hispanics. Journal of the American Medical Association 265, 238241.
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders: A Bio-Social Model. Tavistock Press: London.
Hahn, R. A. (1992). The state of federal health statistics on racial and ethnic groups. Journal of the American Medical Association 267, 268271.
Helzer, J. E., Robins, L. N., McEvoy, L. T., Spitznagel, E. L., Stolzman, R. K., Farmer, A. & Brockington, I. F. (1985). A comparison of clinical and diagnostic interview schedule diagnoses: physician reexamination of lay-interviewed cases in the general population. Archives of General Psychiatry 42, 657666.
Hibbard, J. H. & Pope, C. R. (1986). Age differences in the use of medical care in an HMO: An application of the behavioral model. Medical Care 24, 5266.
Hornblow, A. R., Bushnell, J. A., Well, J. E., Joyce, P. R. & Oakley-Browne, M. A. (1990). Christchurch psychiatric epidemiology study: use of mental health services. New Zealand Medical Journal 103, 415417.
Hough, R. L., Landsverk, J. A., Karno, M., Burnam, M. A., Timbers, D. M., Escobar, J. I. & Regier, D. A. (1987). Utilization of health and mental health services by Los Angeles Mexican Americans and non-Hispanic whites. Archives of General Psychiatry 44, 702709.
Hu, T., Snowden, L. R., Jerrell, J. M. & Nguyen, T. D. (1991). Ethnic populations in public mental health: service choice and level of use. American Journal of Public Health 81, 14291434.
Jones, C. P., La Veist, T. A. & Lillie-Blanton, M. (1991). ‘Race’ in the epidemiologic literature: an examination of the American Journal of Epidemiology, 1921–1990. American Journal of Epidemiology 134, 10791084.
Kessler, L. G., Burns, B. J., Shapiro, S., Tischler, G. L., George, L. K., Hough, R. L., Bodison, D. & Miller, R. H. (1987). Psychiatric diagnoses of medical service users: evidence from the Epidemiologic Catchment Area Program. American Journal of Public Health 77, 1824.
Levkoff, S. E., Cleary, P. D. & Wetle, T. (1987). Differences in determinants of physician use between aged and middle-aged persons. Medical Care 25, 11481160.
Lillie-Blanton, M., Anthony, J. C. & Schuster, C. R. (1993). Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. Journal of the American Medical Association 269, 993997.
Marino, S., Gallo, J. J., Ford, D. A. & Anthony, J. C. (1995). Filters on the pathway to mental health care. I. Incident mental disorders. Psychological Medicine 25, 11351148.
Mezzich, J. E. & Raab, E. S. (1980). Depressive symptomatology across the Americas. Archives of General Psychiatry 37, 818823.
Neighbors, H. W. & Jackson, J. S. (1984). The use of informal and formal help: four patterns of illness behavior in the Black community. American Journal of Community Psychology 12, 629644.
Ormel, J., Koeter, M. W. J., Van den Brink, W. & Van de Willige, G. (1992). The extent of nonrecognition of mental health problems in primary care and its effects on management and outcome. In The Public Health Impact of Mental Disorder (ed. Goldberg, D. and Tantam, D.), pp. 154165. Hogrefe & Huber: Lewiston, New York.
Osborne, N. G. & Feit, M. D. (1992). The use of race in medical research: commentary. Journal of the American Medical Association 267, 275279.
O'Sullivan, M. J., Peterson, P. D., Cox, G. B. & Kirkeby, J. (1989). Ethnic population: community mental health services ten years later. American Journal of Community Psychology 17, 1730.
President's Commission on Mental Health. (1978). Task Panel Reports: The Nature and Scope of the Problem. US Government Printing Office: Washington, DC.
Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z. & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system: Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50, 8594.
Robins, L. N. & Regier, D. A. (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Free Press: New York.
Robins, L. N., Helzer, J. E., Croughan, J. & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry 38, 381389.
Ruiz, D. S. (1990). Social and economic profile of Black Americans. In Handbook of Mental Health and Mental Disorder Among Black Americans (ed. Ruiz, D. S.), pp. 315. Greenwood Press: New York.
Shapiro, S., Skinner, E. A., Kessler, L. G., Von Korff, M., German, P. S., Tischler, G. L., Leaf, P. J., Benham, L., Cottler, L. & Regier, D. A. (1984). Utilization of health and mental health services: three Epidemiologic Catchment Area sites. Archives of General Psychiatry 41, 971978.
Scheffler, R. M. & Miller, A. B. (1989). Demand analysis of mental health service use among ethnic subpopulations. Inquiry 26, 202215.
Strain, L. A. (1991). Use of health services in later life: the influence of health beliefs. Journal of Gerontology 46, S143150.
Sue, S. (1977). Community mental health services to minority groups: some optimism, some pessimism. American Psychologist 32, 616624.
Sussman, L. K., Robins, L. N. & Earls, F. (1987). Treatment-seeking for depression by black and white Americans. Social Science and Medicine 24, 187196.
Vernon, S. W. & Roberts, R. E. (1982). Prevalence of treated and untreated psychiatric disorders in three racial groups. Social Science and Medicine 16, 15751582.
Wan, T. T. H. & Arling, G. (1983). Differential use of health services among disabled elderly. Research on Aging 5, 411431.
Waxman, H. M., Carner, E. A. & Blum, A. (1983). Depressive symptoms and health service utilization among the community elderly. Journal of the American Geriatrics Society 31, 417420.
Wolinsky, F. D. & Johnson, R. J. (1991). The use of health services by older adults. Journal of Gerontology 46, S345357.

Filters on the pathway to mental health care, II. Sociodemographic factors

  • J. J. Gallo (a1), S. Marino (a1), D. Ford (a1) and J. C. Anthony (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed