Inequalities in NHS staff support among those from ethnic minority and migrant groups during the COVID-19 pandemic.

ObjectivesThis study evaluated the differences in clinical outcomes of COVID-19 infection between ethnic minorities and the White ethnic group in the UK. Study designSystematic review and meta-analysis. MethodsThis study included adult residents in the UK with confirmed COVID-19 infection. The outcomes evaluated in this study were mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Outcome data were compared between individuals from ethnic minority groups and individuals from a White ethnic background. MEDLINE, Embase, Cochrane, medRxiv and PROSPERO were searched for articles published between May 2020 and April 2021. The risk of bias was evaluated using the Newcastle–Ottawa Scale checklist. PROSPERO ID: CRD42021248117. ResultsFourteen studies (767,177 participants) were included in the current review. In the adjusted analysis, the pooled odds ratio (OR) for mortality following COVID-19 infection was higher for Black (OR 1.83, 95% confidence interval [CI]: 1.21–2.76, number of studies [k] = 6), Asian (OR 1.16, 95% CI: 0.85–1.57, k = 6) and Mixed and Other (MO) ethnic groups (OR 1.12, 95% CI: 1.04–1.20, k = 5) compared with the White ethnic group. The adjusted and unadjusted ORs of ICU admission for many of the ethnic minority groups were more than double the OR values for the White ethnic group (Black ethnic group = OR 2.32, 95% CI: 1.73–3.11, k = 5; Asian ethnic group = OR 2.34, 95% CI: 1.89–2.90, k = 5; and MO ethnic group = OR 2.26, 95% CI: 1.64–3.11, k = 4). In the adjusted analysis for IMV, the ORs were similarly significantly raised in ethnic minority groups compared with the White ethnic group (Black ethic group = OR 2.03, 95% CI: 1.80–2.29, k = 3; Asian ethnic group = OR 1.84, 95% CI: 1.20–2.80, k = 3; and MO ethnic group = OR 2.09, 95% CI: 1.35–3.22, k = 3). ConclusionThis review found that in the UK, Black, Asian and MO ethnic groups experienced increased COVID-19–related disease severity and mortality compared with the White ethnic group majority.

A Systematic Review and Meta-Analysis of Ethnic Differences in Use of Dementia Treatment, Care, and Research

BackgroundHealthcare workers’ (HCW) well-being has a direct effect on patient care. However, little is known about the prevalence and patterns of long-term medical conditions in HCWs, especially those from ethnic minorities. This study evaluated the burden of multiple long-term conditions (MLTCs), i.e. the presence of two or more single long-term conditions (LTCs), among HCWs in the United Kingdom (UK) and variation by ethnicity and migration status.MethodsWe used baseline data from the UK-REACH cohort study collected December 2020–March 2021. We used multivariable logistic regression, adjusting for demographic, occupational and lifestyle factors to examine the relationship between self-reported LTCs/MLTCs and ethnicity, migration status and time since migration to the UK.ResultsOf 12,100 included HCWs, with a median age of 45 years (IQR: 34–54), 27% were overseas-born, and 30% were from non-White ethnic groups (19% Asian, 4% Black, 4% Mixed, 2% Other). The most common self-reported LTCs were anxiety (14.9%), asthma (12.2%), depression (10.7%), hypertension (8.7%) and diabetes (4.0%). Mental health conditions were more prevalent among UK-born than overseas-born HCWs for all ethnic groups (adjusted odds ratio (aOR) using White UK-born as the reference group each time: White overseas-born 0.77, 95%CI 0.66–0.95 for anxiety). Diabetes and hypertension were more common among Asian (e.g. Asian overseas, diabetes aOR 2.97, 95%CI 2.30–3.83) and Black (e.g. Black UK-born, hypertension aOR 1.77, 95%CI 1.05–2.99) groups than White UK-born. After adjustment for age, sex and deprivation, the odds of reporting MLTCs were lower in most ethnic minority groups and lowest for those born overseas, compared to White UK-born (e.g. White overseas-born, aOR 0.68, 95%CI 0.55–0.83; Asian overseas-born aOR 0.75, 95%CI 0.62–0.90; Black overseas-born aOR 0.52, 95%CI 0.36–0.74). The odds of MLTCs in overseas-born HCWs were equivalent to the UK-born population in those who had settled in the UK for ≥ 20 years (aOR 1.14, 95%CI 0.94–1.37).ConclusionsAmong UK HCWs, the prevalence of common LTCs and odds of reporting MLTCs varied by ethnicity and migrant status. The lower odds of MLTCs in migrant HCWs reverted to the odds of MLTCs in UK-born HCWs over time. Further research on this population should include longitudinal studies with linkage to healthcare records. Interventions should be co-developed with HCWs from different ethnic and migrant groups focussed upon patterns of conditions prevalent in specific HCW subgroups to reduce the overall burden of LTCs/MLTCs.

It is well established that migration and ethnic minority status are risk factors for psychotic disorders. Recent studies have aimed to determine if they are also associated with subclinical psychosis (psychotic-like experiences and schizotypal traits). We aimed to determine to what extent migrant and ethnic minority groups are associated with higher risk of subclinical psychosis. We conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and examined findings by ethnicity, migrant status, outcomes of subclinical psychosis and host country. A meta-analysis was carried out with robust variance estimation where possible, to handle statistically dependent effect size estimates. We included 28 studies (19 studies on psychotic-like experiences and 9 studies on schizotypal traits) and found that ethnicity, but not migrant status, was associated with current and lifetime psychotic-like experiences. In the narrative analysis, we observed the effect of psychosocial risk factors on this association: Black ethnicity groups showed consistent increased prevalence of current and lifetime psychotic-like experiences compared with the reference population across countries. More generalisable and standardised cohort studies of psychotic-like experiences and schizotypal traits in relation to migration/ethnicity are necessary to examine the effects of exposures and outcomes in different contexts, and to understand the underlying mechanisms of the association between subclinical psychosis and migrant and ethnic minority status. None.

Arguably, the strongest evidence of an environmental contribution to the cause of psychosis is the increased risk for certain groups of migrants and ethnic minorities. This article summarizes findings published since 2016. Two studies suggested that migration or minority status are proxies for exposure to an inferior social status. A study from Bologna, Italy, showed that the psychosis risk for internal migrants from Southern Italy was as much increased as that for international migrants. A report from New Zealand reported a higher risk for Maoris than for the remainder of the population.Furthermore, a Danish investigation showed that own-group ethnic density of the neighbourhood at age 15 strongly modified the psychosis risk at adult age. This rules out differential mobility during the prodromal phase as an explanation for the ethnic density effect. Preliminary evidence suggests that the psychotogenic effect of migration may be mediated by elevated dopamine in the striatum. An increasing body of evidence suggests that the higher psychosis risk for certain migrant or ethnic minority groups is due to an inferior social status. Neuroimaging of the dopamine system appears to be a promising avenue for research into pathogenesis.

Improving access and quality for ethnic minority women— panel discussion

The global majority, often called ethnic minority (EM) groups in the United Kingdom (UK), are underserved in clinical trials despite a greater disease burden. This means that the trial results are often not applicable to the global majority, perpetuating inequities. Despite extensive evidence on barriers to inclusive research, there is little evidence on strategies to achieve successful EM participation. The QuinteT Recruitment Intervention (QRI) has been successfully employed in over 80 trials to optimize recruitment and informed consent in the general population. We aimed to adapt the QRI to optimize EM recruitment in trials through public contributor workshops in the UK. We conducted five workshops with 43 public contributors from diverse ethnic backgrounds. We explored concerns of interest to contributors and sought their views on adapting three QRI components (audio-recordings of trial discussions and patient interviews and feedback provided to health-care professionals, HCPs) and QRI information sheets and consent forms. Contributors were most interested in discussing barriers to EM research participation (mistrust, inadequate compensation, lack of workforce diversity in research, and inadequate community outreach). Key suggestions for QRI adaptation included: a) offering a copy of the audio-recorded trial consultation, providing patient interview questions in advance and avoiding small print in patient-facing documentation (to foster trust); b) involving EM groups with lived experience of health conditions in training HCPs (to avoid perpetuating harmful stereotypes; ensure training is "with" EM and not "about" EM); c) providing QRI team's expectations of participants in advance (clarity on emotional/mental labor involved); d) discussing participants' expectations of the research team (QRI interviews are not for medical information provision); and e) providing ample reassurance around confidentiality (to avoid identity disclosure to their communities, HCPs, or the government). It is important to initiate community engagement by focusing on key concerns in the community, though this has been previously well studied (eg, barriers to EM research participation). Providing the space for this prior to discussing our research topic of interest fostered trust. This led to contributors' insightful suggestions to ensure QRI adaptation and acceptability to EM groups, with the aim of ensuring their representation in clinical trials. People from ethnic minority (EM) groups are more affected by health conditions than the general population. Yet, they are missing from trials, including those on health conditions affecting them the most (eg, diabetes). Researchers have a good understanding of issues that may prevent EM trial participation (barriers), but there is little knowledge of which recruitment methods are effective for such groups. The QuinteT Recruitment Intervention (QRI) is a set of methods successfully used to improve recruitment and informed consent in trials in the general population. We wanted to adapt the QRI so that it can be used to recruit people from EM groups to trials. Over five workshops, we asked 43 public contributors from diverse ethnic backgrounds what changes to make to the following QRI methods: audio-recording of trial discussions, feedback provided to doctors and nurses, interviews with patients, and QRI information sheets and consent forms. We did not intend to discuss barriers to research participation as this has been well explored in multiple studies, but this tended to be what our contributors most wanted to talk about (such as their lack of trust in research, researchers, and health-care professionals). After this discussion, they were open to providing suggestions for QRI adaptations, including ways to foster trust (such as offering a copy of the audio-recorded trial consultation to participants). They felt that training for health-care professionals (HCPs) should be "with" input from people from EM groups rather than "about" such groups. They also provided other suggestions, including clarifying that research interviews are not for medical information provision. Overall, we learnt the importance of providing the space to discuss the community's key concerns before discussing our research topic of interest, even when these concerns have been well explored in the existing research. This helped foster trust among contributors and led to important suggestions on how best to adapt the QRI to help ethnic minority participation in trials. We will now work with a wider group of people, including researchers, doctors, and nurses, to take these suggestions forward in our future QRIs.

This chapter considers the work to “retirement” transitions of the rural elders in China who reside in seven regions with substantial minority populations. The data employed, those of the China Household Ethnicity Survey, are ideal for examining the effect of ethnic differences on this key lifecycle event, the reduction of market-oriented work with age. Membership in particular ethnic minority groups is used to proxy potential differences in the social and cultural norms around aging and caregiving. We find that beyond education, the strongest predictors of labor force participation for China’s rural elders are age, disability, widowhood, and ethnic minority status. The effects of ethnic minority group status on labor force participation are robust and the differences in participation among ethnic minority groups are sometimes large. It is thus misleading, in the analysis of the labor force participation of China’s rural elders, to simply dichotomize ethnic minority and majority (Han) group membership. Further careful research is needed to help understand the differences in perceptions of aging among China’s rural ethnic minority groups.

The purpose of this study was to determine if the influences of educational productivity factors on mathematics achievement and attitudes toward mathematics are the same for African Americans and other ethnic groups. Using Walberg's Educational Productivity Model as a framework, this study estimated the influence of home environment, quality and quantity of instruction, use of out-of-school time, peers, perceptions about the usefulness of mathematics in the future, and school socioeconomic status on mathematics achievement and attitude outcomes for students of various ethnic backgrounds. Transcript and survey data representing the factors were collected from 10,001 students who participated in all of the first three waves of the National Longitudinal Study of 1988 (NELS:88). These results suggest that narrowing the gap in student achievement across ethnicity lies in simultaneously optimizing several different alterable factors related to achievement outcomes. Although recent studies have indicated that the gap in achievement test scores among ethnic groups has narrowed appreciably over the years (Cross, 1995; Gross, 1993, Jones, 1985), many of these studies revealed that Asian/Pacific Islander and White students continue to substantially out-perform students from underrepresented ethnic minority groups, particularly African Americans, on tests of mathematics achievement. Moreover, while some ethnic minority groups (e.g., Hispanics and Native Americans) have made substantial gains on mathematics achievement tests in recent years, African Americans have exhibited the least amount of improvement among the major ethnic and language minority groups in the United States (Cross, 1995).' The substantial disparities in mathematics and science achievement between Asian/ Pacific Islanders and Whites and underrepresented minority groups have raised serious concerns among educators and policymakers.2 First, from a national perspective, deficiencies in the education of any ethnic minority group in mathematics and science would subsequently impact the quality and quantity of human resources in the United States. The rationale for this concern comes from the fact that many ethnic minority populations, such as African Americans and Hispanics, have been growing at a much faster rate than other ethnic groups. The Bureau of the Census reported that by 2005, 30% of the United States population will be ethnic minorities and by 2050, the ethnic minority population will be up to 50% (Peng & others, 1995).3 Some authors have posited that failure to improve the education of any ethnic group in science and mathematics could seriously jeopardize the availability of human resources and subsequently hamper the economic advancement and competitiveness of the United States (Bailey, 1990). According to a report by the U.S. Department of Labor, (as cited in Anderson, 1990), between 1986 and 2000, 21 million new jobs will be created in the United States, and many of these new jobs will require basic skills in mathematics and the ability to reason. Furthermore, more than half of these new jobs will require some education beyond high school and almost one-third will require a college education (Anderson, 1990). As underrepresented ethnic minority populations are expected to increase greatly through the year 2000, it is important to encourage students belonging to these groups to focus on academic areas (i.e., mathematics and science) that those jobs will demand (Anderson, 1990). Secondly, ethnic minority populations that have a poor understanding of mathematics and science face possible economic disadvantages in an increasingly technologically-- oriented society and labor market (Bailey, 1990; Peng & others, 1995). Peng and others (1995) reported that among the high school class of 1982 who did not attend college the unemployment rate for students with science and mathematics test scores below the national average was higher than those with scores at or above the national average. …

Much comparative research has charted the difficult relationships that often develop between the police and people with migrant backgrounds, especially those from minority ethnic groups. However there is very little research into the ways in which these issues play out with young teenagers. This chapter first examines the relationships between migrant status and variables relevant to procedural justice theory (mainly perceptions of procedural fairness and of legitimacy) and self-reported crime, amongst the countries that form the UPYC sub-project of the International Self-Report Delinquency Study: France, Germany, the Netherlands, the UK (disaggregated here into English and Scottish sub-samples) and the US. In four out of the six countries and in the analyses combining all six countries, migration has an effect consistent with most previous studies, namely migrants confer less trust and legitimacy on the police. The second part of the paper examines factors that appear to mediate these effects. Living in conditions of disadvantage and in disorganised neighbourhoods explains almost completely the correlation that we observe between migrant status and perceptions of legitimacy. In the third and final part of the paper we look deeper into the effect of migration on trust, legitimacy and self-reported offending by also incorporating ethnic minority status into the analysis. It is shown that minority status is the main driver of the effects apparently associated with migrant status. These results are interpreted in terms of the histories of integration—or of failed integration—of migrants from visible ethnic minorities into the host population. Implications for public policy and social science are discussed.

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessNo Racial Differences Found in Effectiveness of Psychotherapy for DepressionVabren WattsVabren WattsSearch for more papers by this authorPublished Online:19 Mar 2014https://doi.org/10.1176/appi.pn.2014.3b9AbstractWhile there are disparities between Caucasian and racial-minority patients in the use of psychotherapy, when it is used, there are no racial differences in effectiveness.wavebreakmedia/shutterstockThough studies show psychotherapies to be effective in general adult populations with depression, data evaluating whether this effectiveness holds true in racial minority groups with depression remain sparse. Researchers at Vrije University and the EMGO Institute for Health and Care Research, both in Amsterdam, the Netherlands, conducted a meta-analysis to assess the relative effects of psychotherapy for individuals from racial and ethnic minority backgrounds. The study was published February 18 in Psychiatric Services in Advance.“When we started our investigation, we noticed that little is known about the effectiveness of mainstream psychotherapy in depressed migrants in the Netherlands,” Burcin Unlu, M.Sc. the study’s lead author and a doctoral candidate in the Department of Clinical Psychology at Vrije, told Psychiatric News. “As we looked further in the literature, randomized, controlled trials focusing on the effectiveness of psychotherapy in racial-ethnic minorities [of Western civilizations] were also few in numbers.”According to Unlu, research over the past 30 years has indicated that racial and ethnic minority groups are not only underrepresented in clinical trials, but are less likely to make use of mental health care services until late stages of mental illness than Caucasians are. A frequent explanation for this discrepancy, Unlu noted, has been that the lack of cultural and linguistic adaptions to psychotherapy makes mental health services less appealing to people from minority racial and ethnic backgrounds, but the studies confirming this theory are scarce. “The literature isn’t straightforward in the differences in the effectiveness of psychotherapy regarding race,” Unlu said. “Therefore, we decided to select and analyze multiple randomized, controlled trials involving psychotherapy for depression that reported the overall racial-ethnic minority proportion of the sample.”Unlu and colleagues gathered data from 56 randomized, controlled trials—with more than 5,800 participants—that evaluated the effects of psychotherapy in adults aged 18 and older with a depressive disorder diagnosis or an elevated level of depressive symptomatology. Psychotherapy was defined as an intervention in which verbal or written communication between a therapist and a patient was the primary form of therapy—including cognitive-behavioral therapy and intrapersonal psychotherapy. Effectiveness of psychotherapy among the nonminority and racial minority groups was determined by effect size, which was calculated by analyzing changes in depression symptomatology measured by the Beck Depression Inventory and Hamilton Rating Scale for Depression. To meet inclusion criteria, all trials analyzed were required to report subjects’ race and ethnicity. Racial minorities were categorized as people of African, Asian, Hispanic, or Native-American ancestry or ancestry that could not be categorized.Results from the meta-analysis showed that psychotherapy for depression was “moderately” effective in both nonminorities and ethnic minorities, with no significant association between the effect size among the two populations. In addition, no difference in psychotherapy effectiveness was found between each of the minority groups. “Our study shows that we can assume psychotherapy is equally effective regardless of care seekers’ ethnicity,” Unlu told Psychiatric News. “There is not much reason to assume that Caucasians and racial-ethnic minority groups benefit differently from psychotherapy, suggesting that there are universal working mechanisms of psychotherapy for both groups.”Unlu said that depression-based research should now focus on decreasing the disparities in psychotherapy use between Caucasians and ethnic minorities.“Given the results of our study, the question can be shifted to how the delivery of psychotherapy can be improved. Enhancing recruitment methods and culturally sensitive approaches for improving the delivery of psychotherapies to these minorities are important topics for future studies. Culturally adapting psychotherapies to the needs of specific racial-ethnic minority groups may be beneficial in decreasing treatment disparity.” ■“The Effects of Psychotherapy on Depression Among Racial-Ethnic Minority Groups: A Metaregression Analysis” is posted at http://ps.psychiatryonline.org/data/Journals/PSS/0/appi.ps.201300165.pdf. ISSUES NewArchived

To explore differences in severity and nature of symptoms of first-episode psychosis (FEP) according to ethnic group and migrant status. We administered rating scales to assess positive and negative symptoms, as well as general psychopathology, to 301 consecutive patients presenting with an FEP within a defined catchment area in Montreal, Quebec, classified according to ethnicity and migrant status. Symptom scores of Euro-Canadian patients without a recent history of migration, that is, the reference group (n = 145), were compared with those of African and Afro-Caribbean (n = 39), Asian (n = 27), Central and South American (n = 15), Middle Eastern and North African (n = 24), and European and North American (n = 39) patients. Except for referral source, there were no significant differences between ethnic groups on any demographic variables. The African and Afro-Caribbean group had a higher level of negative symptoms (especially alogia) and general psychopathology scores on the Positive and Negative Syndrome Scale (especially, uncooperativeness, preoccupation, and poor attention), compared with the reference group. Ethnic groups did not differ on the Scale for the Assessment of Positive Symptoms scores. A comparison of FEP patients from different ethnic groups and native-born Euro-Canadians revealed no significant differences in the nature of positive symptoms at first presentation or in age at onset, suggesting that there was no evidence for the hypothesis that ethnic minorities are misdiagnosed as psychotic. Increased severity of negative symptoms and general psychopathology, specifically among the black ethnic minority group, may have implications for the role of ethnicity for the treatment and outcome of the initial episode of psychotic disorders.

BackgroundTuberculosis (TB) continues to be a major public health challenge in China. Understanding TB management delays within the context of China’s unique ethnic diversity may be of value in tackling the disease. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays.MethodsThis retrospective cohort study was conducted on patients diagnosed with TB in Hunan Province, China between 2013 and 2018. Diagnosis delay was defined as the time interval between the onset of symptoms and the date of diagnosis. Treatment delay was defined as the time interval between diagnosis and treatment commencement. Univariable and multivariable logistic regression models were used to identify factors associated with TB diagnosis and treatment delay, including ethnic minority status. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to assess the strength of association between the dependant and independent variables.ResultsA total of 318,792 TB patients were included in the study with a mean age of 51.7 years (SD 17.7). The majority of patients were male (72.6%) and Han ethnicity (90.6%). The odds of experiencing diagnosis delay (> 21 days) were significantly higher for Tujia (AOR: 1.46, 95% CI: 1.41, 1.51), Miao (AOR: 1.31, 95% CI: 1.26, 1.37), Dong (AOR: 1.97, 95% CI: 1.85, 2.11), Yao (AOR: 1.27, 95% CI: 1.17, 1.37), and Bai (AOR: 1.45, 95% CI: 1.22, 1.74) ethnic minorities compared to the Han majority. The odds of experiencing treatment delay (> 15 days) were significantly lower for five of the seven ethnic minority groups relative to the Han majority: Tujia (AOR 0.92, 95% CI 0.88, 0.96), Miao (AOR 0.74, 95% CI 0.70, 0.79), Dong (AOR 0.87, 95% CI 0.81, 0.95), Yao (AOR 0.20, 95% CI 0.17, 0.24) and ‘other’ (ethnic minorities that individually represented < 0.1% of the patient population) (AOR 0.70, 955 CI 0.51, 0.97).ConclusionsThis study shows ethnic minority status to be a significant risk factor in diagnosis delay, but for it to reduce the odds of treatment delay. Further research is required to determine the underlying causes of diagnosis delay within ethnic minority populations.

The incidence of schizophrenia and the prevalence of psychotic symptoms in the general adult population are elevated in migrant and ethnic minority groups relative to host populations. These increases are particularly prominent among African-Caribbean migrants to the UK. This study examined the associations of ethnicity and migrant status with a triad of putative antecedents of schizophrenia in a UK community sample of children aged 9-12 years. The antecedent triad comprised: (i) psychotic-like experiences; (ii) a speech and/or motor developmental delay or abnormality; and (iii) a social, emotional or behavioural problem. MethodChildren (n=595) and their primary caregivers, recruited via schools and general practitioners in southeast London, completed questionnaires. Four indices of risk were examined for associations with ethnicity and migrant status: (i) certain experience of at least one psychotic-like experience; (ii) severity of psychotic-like experiences (total psychotic-like experience score); (iii) experience of the antecedent triad; and (iv) severity of antecedent triad experiences (triad score). African-Caribbean children, as compared to white British children, experienced greater risk on all four indices. There were trends for South Asian and Oriental children to present lowered risk on several indices, relative to white British children. Migration status was unrelated to any risk index. ConclusionPrevalence of the putative antecedents of schizophrenia is greater among children of African-Caribbean origin living in the UK than among white British children. This parallels the increased incidence of schizophrenia and elevated prevalence of psychotic symptoms among adults of African-Caribbean origin.

Previous research on mental health disparities shows that persons from racial-ethnic minority groups have less access to mental health care, engage in less treatment, and receive poorer-quality treatment than non-Hispanic whites. Attitudes and beliefs about mental health treatment were examined to determine whether they contribute to these disparities. Data from the National Comorbidity Survey Replication (NCS-R) were analyzed to determine attitudes toward treatment-seeking behavior among people of non-Hispanic white, African-American, and Hispanic or Latino race-ethnicity. Additional sociodemographic variables were examined in relation to attitudes and beliefs toward treatment. African-American race-ethnicity was a significant independent predictor of greater reported willingness to seek treatment and lesser reported embarrassment if others found out about being in treatment. These findings persisted when analyses adjusted for socioeconomic variables. Hispanic or Latino race-ethnicity also was associated with an increased likelihood of willingness to seek professional help and lesser embarrassment if others found out, but these differences did not persist after adjustment for the effects of socioeconomic variables. Contrary to the initial hypothesis, African Americans and Hispanics or Latinos may have more positive attitudes toward mental health treatment seeking than non-Hispanic whites. To improve access to mental health services among racial-ethnic minority groups, it is crucial to better understand a broader array of individual-, provider-, and system-level factors that may create barriers to care.