County Context and Mental Health Service Utilization among Older Racial and Ethnic Minorities

Abstract

Underutilization of mental services by older racial and ethnic minorities is a growing concern in the United States, as it may have a huge impact on the older adults' well-being and generate significant financial costs. Using Andersen's (2008) Behavioral Model of Health Services Utilization, this study examined county contexts associated with mental health service use among older racial and ethnic minorities in the United States, controlling for individual characteristics. This study used the 2008-2012 Medical Expenditure Panel Survey linked with county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse. This study included 1,143 Hispanic Americans (156 counties), 1,567 Black Americans (237 counties), and 422 Asian Americans (81 counties). Two separate multilevel logistic regressions for Hispanics and Blacks and one multiple hierarchical logistic regression for Asians were conducted to examine which factors were related to mental health service utilization among the three groups. At the individual-level, better mental health status decreased the odds of using mental health services in all three groups. Higher individual income was a significant predictor of mental health service utilization for the Black and Asian samples but not the Hispanic sample. In addition, having a high school diploma significantly predicted mental health service utilization only among older Hispanics. At the county-level, the findings varied across groups. A higher proportion of older adults in a county increased mental health service utilization among older Hispanics but decreased utilization among older Asians. In addition, a higher proportion of Black residents was related to decreased use of mental health services by older Blacks. The existence of community mental health centers in a county significantly predicted mental health service utilization by older Hispanics. This study suggests that county contexts may be helpful to understand mental health service utilization among older racial and ethnic minorities, even adjusting for individual-level characteristics. The findings varied across the three groups, indicating the need for further research. Social workers and policymakers should understand both individual- and county-level characteristics associated with mental health service utilization to develop tailored outreach programs as well as to develop and evaluate mental health policy.