Journal
MEDICAL CARE
Volume 55, Issue 2, Pages 173-181Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0000000000000638
Keywords
race/ethnicity; provider discrimination; mental health; substance abuse
Categories
Funding
- National Institute of Drug Abuse [DA 15539, DA 20826]
- National Institute of Minority Health Disparities [MD 00508, MD006923]
- VA Office of Academic Affiliations Associated Health Professions
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Background: Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. Research Methods: We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment. In a sample of 1099 adults (age 18-72) who indicated prior year mental health/substance abuse visits, we examined: experiences of discrimination that occurred during health care and mental health/substance abuse visits, ratings of treatment helpfulness, and reports of stopping treatment early. Results: Fifteen percent of California adults reported discrimination during a health care visit and 4% specifically during mental health/substance abuse visits. Latinos, the uninsured, and those with past year mental disorders were twice as likely as others to report health care discrimination [adjusted odds ratio (AORs) = 2.08, 2.77, and 2.51]. Uninsured patients were 7 times more likely to report discrimination in mental health/substance abuse visits (AOR = 7.27, P < 0.01). The most commonly reported reasons for health care discrimination were race/ethnicity for blacks (52%) and Latinos (31%), and insurance status for whites (40%). Experiences of discrimination in mental health/substance abuse visits were associated with less helpful treatment ratings for Latinos (AOR = 0.09, P < 0.05) and whites (AOR = 0.25, P < 0.01), and early treatment termination for blacks (AOR = 13.38, P < 0.05). Conclusions: Experiences of discrimination are associated with negative mental health/substance abuse treatment experiences and stopped treatment, and could be a factor in mental health outcomes.
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