Marg argar arit ita A a Ale legria, ia, PhD, , Professor or, Depar artment of Psyc ychiat atry, y, Har arvar ard Medic ical al School, l, an and Dire irector, r, Center for r Mult ltic icult ltural M al Mental H al Healt alth Resear arch, Cam ambrid ridge Healt alth Allian lliance, Be Benj njamin n Cook, PhD PhD, , Assista tant t Pro rofessor, Depar artment o of Psyc ychiat atry ry, Harv arvar ard Medi dical Sc School hool and d Se Senior Resear arch Scie ientis ist, Center for r Mult ltic icult ltural al Mental al Healt alth Resear arch, Cam ambrid ridge Healt alth Allian lliance Stephen en Loder, , BA, , Res Research ch Coord rdinat ator, Center r for Mult lticultural ral Mental al Healt alth Res Research ch, , Ca Cambridge Healt alth Allian lliance Mic ichae ael l Doon Doonan, PhD PhD, Associate Professor, The Heller School for Social Policy and Management, Brandeis University Massachusetts H Healt lth P Polic licy Fo Foru rum S Summit it , , De Dec. 1 . 11, 2 , 2014
Massachusetts (MA) is an increasingly diverse state with more than 25% adult minority population. For children the proportion is higher-34% . 14.8% of the state population is foreign-born. 21.7% speaks a language other than English at home.
Untreated behavioral health . conditions have been linked to : Augmented suffering for family • caregivers One of the leading and growing • causes of disability Reduced life expectancy-estimates • range from 10-20 years. Increased morbidity and worst • self-management of chronic conditions. Increased likelihood of • unemployment, unwanted pregnancy, homelessness, incarceration, school dropout and many others.
What is it about? What it is not about? Analyzing available data A compilation of all data to describe current status. sources in MA. Examining literature and A step-by-step action other evidence to identify plan of evidence-based potential solutions to disparities interventions. problems. A description of all Generating a discussion actions, policies and that leads to an action interventions being done plan. in MA.
Based on WHO Based on Institute of definition as Medicine definition as differences in health differences in service which are not only use that are not unnecessary and justified by avoidable and, in underlying health addition, are conditions or patient considered unfair preferences. and unjust. Behavioral Health Behavioral Health Disparity Service Disparity
Review Data Sources Model of Potential Mechanisms Explaining Explain Analytical Methods Disparities Ethnic/Racial Diff in Rates of Present Recommendations Mental Illness for Adults Give Rationale for Ethnic/Racial Disparities in Recommendations Mental Health Services Generate a Discussion of Ethnic/Racial Diff in Rates of these alternatives. Substance Use for Adults Ethnic/Racial Disparities in Substance Tx Completion
National Survey of Drug Use and Health (NSDUH) ◦ ~5,000 MA residents interviewed between 2004 and 2012 Treatment Episode Data Set (TEDS) (2013) ◦ ~18,000 publicly funded treatment center admissions (~65% of all treatment admissions) 2005-2013 Youth Risk Behavior Surveillance System (YRBSS) among Massachusetts high school students 2012 MA Behavioral Risk Factor Surveillance System (BRFSS) Boston Survey of Children's Health, 2012
Overall goal to compare rates of mental illness and substance use and service use among adults and youth in Massachusetts ◦ Age- and gender- adjustment for racial/ethnic comparisons of rates of mental illness and substance use ◦ Age- and gender- and “need”-adjustment for racial/ethnic comparisons of rates of service use ◦ Some but not all analyses weighted to be representative of the state of Massachusetts
Lower among racial/ethnic Any mental illn illness in in the la last y year minority groups in amon mong a adul ults i in n US a and nd MA the U.S. 18 16 Lower among * 14 * Asians in MA 12 White * 10 Black No significant 8 Asian * 6 differences among Latino 4 Latinos, Blacks, 2 0 and Whites US MA *difference from Whites is significant at p<.05. Age- and gender-adjusted estimates of last year mental illness. Mental illness defined based on models using K-6 scale of psychological distress and WHO-DAS scale of disability National Survey of Drug Use and Health (NSDUH); Sample size for US=365,200; MA=5,000
Percent of Adults Ever Diagnosed with Depression or Reporting Poor Mental Health in the Last Year, 2012 Massachusetts BRFSS Latinos report Depression ion D Dia iagnos osis is (L (Lifetim ime) Poo oor M Mental l He Healt lth higher lifetime 26 26.3 depression 20 20.4 Blacks and 19.5 19 Latinos more 15.5 15 14.7 14 likely to report 11 11.3 poor mental 5.4 5. health Not available Whit Wh ite Bla lack Latin ino Asi sian Age-adjusted estimates. Source: Massachusetts Department of Public Health. A Profile of Health among Massachusetts Adults, 2012: Results from the Behavioral Risk Factor Surveillance System (BRFSS). 1
Significant U.S. Any mental health services in the disparities in mental last t year among indiv ivid iduals with th ment ntal illne ness ss in US and d MA (NSDU DUH health service use 200 2004-201 2012) 2) In MA, significant 60 Latino-white 50 White * * 40 disparities. * Black 30 * Asian 20 Blacks and Asians 10 Latino doing better on this 0 US MA measure than other parts of the U.S. *significant at p<.05 level Data from the 2004-2012 National Survey of Drug Use and Health among adults predicted to have mental illness based on K-6 scale of psychological distress and WHO-DAS scale of disability due to mental illness. Estimates are age- and gender-adjusted n=65,100 for US and n=900 for MA
Last year r use a among a adu dult lts in in Last y year u r use among adu dult lts in in MA MA 18 3.5 16 3 14 2.5 12 White White 2 10 Black Black 8 1.5 * Asian Asian 6 Latino Latino 1 4 * 0.5 2 0 0 cocaine hallucinogens marijuana Rates of substance use were similar or greater among whites compared to minorities Age- and gender-adjusted estimates of substance use within the last year among adults 18+. Data from the 2004-2012 National Survey of Drug Use and Health (NSDUH); n=5,600. * Significantly different from white (p<0.05)
Once in treatment, Latinos and * Asians are less * * likely to complete * treatment. * 2013 Treatment Episode Data Set * Difference from whites is significant at p<.05 level
Adult Mental Illness ◦ Latinos more likely to report lifetime depression ◦ Latinos and Blacks more likely to report poor mental health Adult Mental Health Treatment ◦ Significant Latino-white disparities in MA ◦ Blacks and Asians doing better on mental health care access than rest of U.S. Adult substance use ◦ No or “reverse” disparity in substance use Adult substance use treatment ◦ Once in treatment, Latinos and Asians are less likely to complete treatment ◦ Blacks and Native Americans less likely to complete alcohol treatment in MA
Percent of MA high school students Compared to experiencing depressive symptoms or suicidal thoughts/ attempts (YRBS 2005-2013) white students, 35.00% * 30.00% * Hispanics and * 25.00% * Native Americans White * 20.00% * Asian had higher rates 15.00% * Black of 10.00% Hispanic * Multi 5.00% ◦ Sadness Native Am 0.00% Feeling sad on Suicidal Ideation Suicidal attempt ◦ suicidal ideation most days for more than 2 ◦ suicidal attempt weeks Age-adjusted data from the 2005-2013 Youth Risk Behavior Surveillance System among Massachusetts high school students * Significantly different from white (p<0.05) (Feeling sad: n=14188, suicidal ideation: n=14,307, suicidal attempt: n=14,209)
Per erce cent o of youth a ages es 12 12-17 wit ith d depre ression re receiv iving las last Latino-white ye year ar mental h al healt alth tre reat atment disparities in youth 40 depression treatment 35 30 White 25 * * * Black 20 Asian 15 Latino * 10 5 0 US MA Data from the 2004-2012 National Survey of Drug Use and Health among youth ages 12-17. Adjusted for age, sex, and depression diagnosis (n=15,100 in US and n=200 in MA) * Difference from whites is significant at p<.05 level
Per erce cent o of MA youth a ages es 12 12- 17 17 rep eported ed h having co consumed ed mar ariju ijuana a or alc r alcohol at at le leas ast Less use of once in in the las last ye year ar (NSDUH marijuana among 2004-2012) 2004 Blacks, Asians, and 40 Latinos compared 35 to whites 30 * Less use of alcohol White 25 * Black 20 among Blacks and * Asian 15 Asians compared * * Latino 10 to whites 5 0 marijuana alcohol Age- and gender-adjusted estimates from the 2004-2012 NSDUH among Massachusetts youth (ages 12-17). (n=2,800) * Significant at p<.05 level
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