Disparities In Utilization Of Services Research Articles

The Influence of Socioeconomic Factors on Access to Mental Health

Mental health is a pivotal aspect of overall well-being, yet access to mental health services is unevenly distributed across different socioeconomic groups. This study explores the influence of socioeconomic factors—such as income, education, employment status, and housing—on access to mental health care. Employing a mixed-methods approach, the research integrates quantitative analysis of survey data with qualitative interviews to reveal significant disparities in service utilization. Findings indicate that individuals from lower socioeconomic backgrounds face substantial barriers, including financial constraints, stigma, and geographic limitations. The study underscores the persistent nature of these inequalities and highlights the need for targeted policy interventions and systemic reforms. Expanding insurance coverage, reducing stigma, and increasing mental health infrastructure in underserved areas are critical for improving access. Future research should focus on evaluating policy impacts and exploring innovative service delivery models.

SOCIOECONOMIC DISPARITIES IN PHYSICAL AND OCCUPATIONAL THERAPY HOME HEALTH CARE VISITS FOR PEOPLE WITH DEMENTIA

Abstract People living with Dementia (PLWD) utilize Home Health Care (HHC) services such as Physical Therapy (PT) and Occupational Therapy (OT), but little is known about service utilization patterns among PLWD from different socioeconomic backgrounds. We aimed to identify disparities in service utilization in PLWD in a HHC setting across socioeconomic backgrounds using a measure of geographic socioeconomic deprivation, the Area Deprivation Index (ADI). ADI is a composite measure of census variables describing socioeconomic disadvantage, reported as national percentile rank. This secondary analysis utilized data collected February 2017–May 2022 in a dementia symptom management clinical trial at a large, urban, Medicare certified nonprofit HHC agency in New Jersey. Demographic and service utilization data from 153 dyads of PLWD and caregivers was collected. PLWD’s area codes were used to calculate ADI. ADI national percentile was divided into quartiles, and PT and OT utilization for the highest quartile was compared to the three lowest quartiles using Poisson regression, consistent with previous literature. The highest quartile group was defined as ADI above the 36.5th percentile. ADI varied from 2nd to 73rd percentile, with a median of 24th percentile. Analysis controlled for pre-existing comorbidities using pre-trial Charlson Comorbidity Index scores, classified as high (>5), medium (3-4), or low (1-2). High ADI classification was associated with a 50.2% decrease in OT utilization (IRR=.498, CI=.348-.713), and 39.4% decrease in PT utilization (IRR=.606, CI=.485-.759). Further investigation of disparities in PT and OT utilization in HHC is needed, given the disproportionate burden of disease on socioeconomically distinct populations.

The unique pathways to coordinate specialty care for Black families navigating early psychosis: A preliminary report.

Aversive pathways to coordinated specialty care (CSC) for first episode psychosis have been linked to the extended duration of untreated psychosis, limited engagement, and treatment outcomes. Yet there has been very limited research that has solely explored the unique pathways to care among Black families in the U.S. This study utilized qualitative methods to explore the pathways to CSC among Black individuals experiencing their first episode of psychosis and their family members. Individuals who were or are enrolled in CSC programs and/or their family members were recruited to participate in semi-structured qualitative interviews. Qualitative interviews were used to characterize events and experiences prior to the initiation of CSC. All interviews were transcribed verbatim and analyzed using a qualitative descriptive approach. A total of 14 participants were recruited to complete semi-structured interviews. Findings revealed that during prodromal phase participants noticed changes in social functioning, identified prior childhood experiences that were viewed as traumatic, and sought very little help from formal sources. After the onset of psychosis, the majority of participants highlighted the importance of family members in the initiation of care, yet also expressed difficulties navigating services and engaging with clinical staff, contributing to further delays to the initiation of CSC. Finding from this study sheds light on understanding known disparities in utilization of services and potentially identifies areas that can be leveraged to improve the experiences for Black families seeking CSC.

Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study.

AimsFew studies have focused on the utilization of rehabilitation services among people with schizophrenia. In this study, we aimed to examine the trend of pharmacological and psychotherapy service utilization among adults with schizophrenia and to identify the associated socioeconomic factors.MethodsData were obtained from the Second National Sample Survey on Disability in 2006 and from the follow-up investigation in 2007–2013. Individuals with schizophrenia were ascertained by the combination of self-reports and on-site diagnosis by psychiatrists. Random effect logistic regression models were applied to examine the socioeconomic disparity in service utilization and the time trend in the association.ResultsOverall, the percentage of individuals using pharmacological treatment services increased from 23.7 in 2007 to 55.0% in 2013, and the percentage of individuals using psychotherapy services increased from 11.4 to 39.4%. Living in rural areas, being illiterate, living in families with lower income and being uninsured were less likely to receive pharmacological treatment and psychotherapy. The pace of growth in service utilization was higher among individuals with rural residence, illiteracy or low-income status than among their counterparts with advantaged backgrounds.ConclusionsThis study demonstrated an upward trend in pharmacological treatment and psychotherapy service utilization and a downward trend in socioeconomic disparity among Chinese adults with schizophrenia. Future studies to explore the reasons for the observed changes and to identify policies for improving the health service access of this vulnerable group are warranted.

Levels, Trends, and Inequalities in Using Institutional Delivery Services in Low- and Middle-Income Countries: A Stratified Analysis by Facility Type.

To ensure equitable and accessible services and improved utilization of institutional delivery it is important to identify what progress has been achieved, whether there are vulnerable and disadvantaged groups that need specific attention and what are the key factors affecting the utilization of institutional delivery services. In this study, we examined levels, trends, and inequalities in the utilization of institutional delivery services in low- and middle-income countries. We used nationally representative cross-sectional data from Demographic and Health Surveys (DHS) conducted during 1990-2018. Bayesian linear regression analysis was performed. Among 74 countries, the utilization of institutional delivery services ranged from 23.7% in Chad to 100% in Ukraine and Armenia (with >90% in 19 countries and <50% in 13 countries) during the latest DHS rounds. Trend analysis in 63 countries with at least 2 surveys showed that the utilization of institutional delivery services increased in 60 countries during 1990-2018, with the highest increase being in Cambodia (18.3%). During this period, the utilization of institutional delivery services increased in 90.3% of countries among the richest, 95.2% of countries in urban, and 84.1% of countries among secondary+ educated women. The utilization of institutional delivery services was higher among wealthiest, urban, and secondary+ educated women compared to their counterparts. Greater utilization of private facilities for delivery was observed in women from the highest income group and urban communities, whereas highest utilization of public facilities was observed for women from the lowest income group and rural communities. The utilization of institutional delivery services varied substantially between and within countries over time. Significant disparities in service utilization identified in this study highlight the need for tailored support for women from disadvantaged and vulnerable groups.

Exploring Ethnic Differences in Caregiver Perceptions of the Quality of Children’s Mental Health Care

The U.S. children’s mental health system is faced with ameliorating the impacts of significant ethnic disparities in service utilization and outcomes. Furthermore, there has been little effort to assess the quality of children’s mental health care. In this study, we compare Haitian, African-American, and White caregiver perceptions of the quality of their child’s mental health care. Four overarching domains were examined: access to care, cultural and linguistic competence, engagement of caregivers, and appropriateness of services. Through the analysis, we identify ethnic differences in the experiences of caregivers in accessing and receiving services for their children, with minority caregivers reporting greater barriers and poorer quality of care. Structural and cultural factors are explored to understand the interaction of multiple processes that shape access to and quality of care. Implications for policy and practice are discussed, including the need for greater cultural competency and responsiveness in mental health care, and the need to build greater trust between providers and minority communities.

Disparities in utilization of services for racial and ethnic minorities with hepatocellular carcinoma associated with hepatitis C

BackgroundHepatitis C affects racial minorities disproportionately and is greatest among the black population. The incidence of hepatocellular carcinoma has increased with the largest increase observed in black and Hispanic populations, but limited data remain on whether hepatitis C hepatocellular carcinoma in racial-ethnic minorities have the same utilization of services compared with the white population. MethodsWe used the database of the National Inpatient Sample to identify hepatitis C-hepatocellular carcinoma patients (N = 200,163) who underwent liver transplantation (n = 11,491), liver resection (n = 4,896), or ablation of liver lesions (n = 6,933) from 2005 to 2015. We estimated utilization over time and assessed differences in utilization and inpatient mortality across patient characteristics. ResultsIn multivariate analysis, factors associated with utilization of services included treatment year, sex, race, insurance status, hospital type, and comorbidity burden, with black and Hispanic patients having statistically significantly decreased utilization. Factors associated with inpatient mortality included treatment year, sex, race, insurance status, hospital type, hospital region, and comorbidity burden, with black patients having a statistically significantly greater risk of inpatient mortality. ConclusionWe identified racial and socioeconomic factors which were associated with utilization of services and inpatient mortality for patients with hepatitis C hepatocellular carcinoma. Blacks were especially disadvantaged in the receipt of care. Further work to abrogate these findings is imperative to ensure equitable provision of surgical therapies.

Multiple Stakeholder Perspectives on School-Based Responses to Student Suicide Risk in a Diverse Public School District

Schools across the US have implemented suicide prevention procedures to detect risk among students and facilitate linkage to mental health services. Yet, many students at risk for suicide do not access mental health treatment, and significant racial/ethnic disparities in service utilization persist. Quality improvement of suicide prevention procedures is needed to enhance care for suicidal youth. The present study examined perspectives of multiple stakeholders involved in school-based suicide prevention procedures through a qualitative design, in order to generate a set of quality improvement targets. Participants included school staff, students assessed for suicide risk at school, and their caregivers. Results indicated points of commonality and divergence across stakeholder groups. Students and parents described feelings of exclusion from decision-making processes, perceptions of rigid and disciplinary assessment procedures, traumatic experiences with crisis intervention, and practical barriers and facilitators to follow-up services. Staff perspectives highlighted positive regard for standardized protocols, efforts to reduce negative student experiences with assessment procedures, prioritization of student safety, and potential practical and attitudinal barriers and facilitators to follow-up care. Given these findings, a set of quality improvement targets is proposed and discussed, with a focus on family-centered interventions to promote engagement.

Rural\u2013urban disparities in the utilization of mental health inpatient services in China: the role of health insurance

Reducing rural–urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural–urban disparities in the utilization of mental health inpatient services in China. This retrospective study used 10 years (2005–2014) of hospital electronic health records from the Shandong Center for Mental Health and the DaiZhuang Psychiatric Hospital, two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural–urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Consistent with the existing literature, our study suggests that increasing insurance schemes’ reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in rural–urban disparities in service utilization. In order to promote mental health care and reduce rural–urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.

Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance

Objective: Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China. Methods: This retrospective study used 10 years (2005–2014) of hospital electronic health records (EHRs) from the Shandong Center for Mental Health (SCMH) and the DaiZhuang Psychiatric Hospital (DZPH), two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Results: Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Conclusion: Consistent with the existing literature, our study suggests that increasing insurance schemes’ reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in 3 rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.

Associations Between Multi-Level Contextual Factors and Mental Health Service Utilization in Adolescents with Comorbid Depression and Substance-use: Moderating role of School Connectedness on Racial/Ethnic Disparities in Service Utilization

Background: Comorbid depression and substance use has been a prevalent issue in adolescent health. Although rates have remained relatively stable, their level is still alarming and efforts to see a decrease have led leaders and organizations to call for research to better understand factors related to both depression and substance use as well as how these factors may change when these disorders occur together.

Services for children with autism in the Kingdom of Saudi Arabia.

Little information is available about autism spectrum disorder services in the Kingdom of Saudi Arabia. A sample of 205 parents completed an online survey about the use of autism spectrum disorder services for their children. The results revealed that on average, children began services by 3.3 years. Most parents reported utilizing non-medical treatments followed by biomedical treatments and cultural and religious treatment. The age at the initiation of services and the type of treatments used differed by parent's income, educational attainment, the extent of knowledge about autism spectrum disorders, and geographic location. Some child characteristics also influenced the use of services. The disparities in service utilization in Saudi Arabia point to the need to develop policy and interventions that can mitigate the paucity of services for children with autism spectrum disorders. More research is needed to better understand service use and the decision-making processes that underlie treatment selection by parents of children with autism spectrum disorders in the Kingdom of Saudi Arabia.

Cancer Risk Factors Among Adults with Serious Mental Illness

Background There is strong evidence to suggest that adults living with serious mental illness have a higher risk of mortality and morbidity than the general U.S. population, including a higher risk of mortality associated with certain cancers and cancer-related deaths. The potential loss of life expectancy among this population may be as high as 25 years compared to those without a mental illness. There are numerous challenges faced by people with serious mental illness, and behavioral factors that may contribute to increased cancer risk, including high prevalence of smoking, obesity, physical inactivity, substance abuse, and infectious diseases. Many of these individuals are uninsured, homeless, have a dual diagnosis of substance abuse, and are least likely to access and use preventive healthcare services. There is growing concern that those with serious mental illness experience disparities in health education, health prevention services, cancer screening, access to diagnostic testing, cancer case recognition, and higher cancer case fatalities. Although there are many interrelated and complex factors associated with cancer-related risk among this vulnerable population, many of these factors can be addressed. This paper aims to increase awareness of cancer risk factors and implications of employing innovative health promotion and cancer-prevention strategies among people with serious mental illness.

The Effects of Race and Other Socioeconomic Factors on Health Service Use Among American Military Veterans

This study examined the extent to which racial disparities in service utilization exist in veterans (VA) and non-VA health care systems. An observational study design was used with a nationally representative sample of veterans. Logistic regression models were constructed using sociodemographic characteristics, health insurance and benefits, and health status as predictors of health service use in both VA and non-VA health care systems. A population weighted sample of 19,270 veterans from the 2001 National Survey of Veterans was used, which included 17,004 (88.24%) White, 1,864 (9.15%) African American, 414 (2.15%) Native American/Alaskan Native, and 87 (0.45%) Asian American/Pacific Islander veterans. Results showed that use of the VA health care system was not associated with race, but was associated with VA disability compensation, lack of private health insurance, and greater health care need. Contrarily, in non-VA healthcare systems, veterans who were racial minorities, less educated, and without private health insurance were less likely to use services. Together, these findings demonstrate the socioeconomic context in which health disparities exist and suggest the influence of health insurance on racial disparities in service utilization.

Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

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.

Investigation of racial and ethnic disparities in service utilization among homeless adults with severe mental illnesses.

This study examined whether there are service disparities among homeless adults with severe mental illnesses, a vulnerable population with a high level of unmet need. Data were collected at baseline for 6,829 black, Latino, and non-Latino white participants in the Access to Community Care and Effective Services and Support study. Outcome variables were measures of utilization of psychiatric outpatient, housing, and case management services in the previous 60 days. The sample was divided into white-black and white-Latino cohorts. Within each cohort, participants were stratified into comparable groups by propensity scores that estimated log-odds of being black or Latino as a function of several confounding variables. White-black and white-Latino differences in mean number of visits (a measure of intensity) and in the mean probability of at least one visit (a measure of access) were subsequently estimated for each of the three services. The composition of the sample was 50% black, 6% Latino, and 44% white. Service utilization was low for the three services regardless of race-ethnicity. On multivariate analyses of service utilization in the previous 60 days, blacks made fewer psychiatric outpatient visits than whites (mean difference=.46, 95% confidence interval [CI]=.10 to .81]), yet Latinos had more case management visits than whites (mean difference=-.51, CI=-1.03 to -.05]). Analyses of access did not reveal racial-ethnic disparities. Whereas blacks used psychiatric outpatient services less frequently than whites, hence experiencing a service disparity, Latinos used case management services more than whites did. Possible contributors and clinical and methodological implications of these results are discussed.

Investigation of Racial and Ethnic Disparities in Service Utilization Among Homeless Adults With Severe Mental Illnesses

This study examined whether there are service disparities among homeless adults with severe mental illnesses, a vulnerable population with a high level of unmet need. Data were collected at baseline for 6,829 black, Latino, and non-Latino white participants in the Access to Community Care and Effective Services and Support study. Outcome variables were measures of utilization of psychiatric outpatient, housing, and case management services in the previous 60 days. The sample was divided into white-black and white-Latino cohorts. Within each cohort, participants were stratified into comparable groups by propensity scores that estimated log-odds of being black or Latino as a function of several confounding variables. White-black and white-Latino differences in mean number of visits (a measure of intensity) and in the mean probability of at least one visit (a measure of access) were subsequently estimated for each of the three services. The composition of the sample was 50% black, 6% Latino, and 44% white. Service utilization was low for the three services regardless of race-ethnicity. On multivariate analyses of service utilization in the previous 60 days, blacks made fewer psychiatric outpatient visits than whites (mean difference=.46, 95% confidence interval [CI]=.10 to .81]), yet Latinos had more case management visits than whites (mean difference=-.51, CI=-1.03 to -.05]). Analyses of access did not reveal racial-ethnic disparities. Whereas blacks used psychiatric outpatient services less frequently than whites, hence experiencing a service disparity, Latinos used case management services more than whites did. Possible contributors and clinical and methodological implications of these results are discussed.

Differences in Mental Health Service Sector Utilization among African American and Caucasian Youth Entering Systems of Care Programs

Differences in unmet need and access to services between African American and Caucasian youth have been established; less is known about differences in specific mental health service sectors. This study examined differences in past year outpatient, school-based, day treatment and residential/inpatient service utilization among African American and Caucasian youth (n = 3,649) entering a federally funded system of care program. Random effect logistic regression models were implemented to examine the relationship between race and past year service utilization. Analyses revealed that African American youth were less likely than Caucasian youth to have utilized school-based and residential/inpatient mental health services in the past year. Findings suggest that racial disparities exist in service use for certain types of service sectors and highlight the importance of understanding and identifying individual, family, and community factors that contribute to disparities in service utilization.

Disparities in service utilization and expenditures for individuals with developmental disabilities

Background The factors that affect access to services for individuals with developmental disabilities (DD) have not received much attention. Methods This study examined service utilization and expenditures provided by regional centers to individuals with DD living at home and in residential settings in California in 2004–2005. Logistic regressions of secondary data were used to predict the receipt of services, and ordinary least squares regressions were used to examine the predictors of service expenditures. Results Of the 175,595 individuals assessed with DD, 21% did not receive any purchased services from regional centers in 2004–2005. Controlling for client needs, individuals aged 3–21 years were less likely than other age groups to receive services. All racial and ethnic minority groups were less likely to receive any services than were whites. The supply of intermediate care facilities for habilitation and residential care reduced the likelihood of receiving regional center services. Of those who received services, younger individuals and all racial and ethnic minority groups had significantly lower expenditures. Provider supply, area population characteristics, and regional centers also predicted variation in service use and expenditures. Conclusion The disparities by age, race/ethnicity, and geographic area require further study, and specific approaches are needed to ensure equity in access to services.