Medical doctors' behaviors may lead to health care disparities

Patient reported differences in the way medical doctors assess, treat and refer racial and ethnic minorities for mental health services may contribute to disparities in their use, according to a new study in Health Services Research.

"We know certain groups of people often have worse mental health, possibly due to lack of access to specialty care," said study author Oanh Meyer. "This may be because
providers under-recognize their problems or have implicit, unconscious biases that affect the way they treat racial/ethnic minorities or other underserved groups."

Previous research finds that most people who experience mental health distress first seek help from a medical health provider, who may not recognize mental health problems, the authors noted. "Using a very large, nationally representative data set, we looked at how often racial/ethnic minority patients were asked about mental health and substance abuse," Meyer said. "We also wondered whether they were being counseled, receiving medications and being referred to specialty care."

The researchers used data from 3,447 respondents in the National Comorbidity Survey-Replication and the National Latino and Asian American Study household surveys conducted between 2001-2002 and 2002-2003. Their analysis of patient-reports of medical doctors' assessment, treatment and recommendations for mental health problems noted the following:

In analyses involving only race, Asian-Americans were less likely to be asked about mental health and substance abuse than non-Hispanic whites. These differences disappeared when accounting for clinical severity and other sociodemographic factors such as age, gender, education and whether they had insurance.

Blacks were less likely to receive recommendations for medication for a mental health or substance abuse problem when compared to whites. Latinos were more likely to receive counseling and a recommendation for specialty care when compared to whites.
Patients born in the United States were more likely to receive a recommendation for medications.

People with insurance received more inquiries about mental health or substance abuse from the initial provider.

"In some ways this study adds more questions than it answers," Meyer noted. "In the future, we will look at other factors that might also contribute to health care disparities, including how access to care might vary by neighborhoods."

David T. Takeuchi, PhD, professor and the inaugural Dorothy Book Scholar at Boston College Graduate School of Social Work, added, "Past research consistently shows that people from diverse communities are less likely to access mental health care for their problems. This basic finding has endured for over 40 years and while there are many reasons for it, this study shows that some of the reasons may be due to how people perceive and report about provider behaviors."

"The study does a wonderful job of making excellent use of the available data to show that some racial and ethnic minority groups receive disparate types of treatments and perceive providers differently, which may in turn constrain or facilitate access to quality services," Takeuchi noted. "It also gives unique insights into possible interventions and other research studies that can further our understanding about removing the barriers for people to receive better care."