An expanding literature documents gender differences in the prevalence, patterns of symptoms, clinical course and burden of specific mental disorders. This proposed research draws on both that knowledge and insight into men and women's help-seeking behaviors to examine the potential differential impacts by gender of a change in health system organization. This study investigates the impact of a managed behavioral health carve-out on: self-perceived problem recognition for depression and alcohol disorders and related help seeking; access to formal care; access to specialty care; and intensity of treatment. This work uses survey data collected in face-to-face interviews with a probability sample of adults living in low-income areas of Puerto Rico. Data was collected in three waves, with the last wave occurring after implementation of managed care. A quasi-experimental design will be used to identify the carve-out's effect, using non-affected regions as a nonrandomized comparison group. Study findings may translate into gender-specific strategies for public awareness initiatives, prevention, screening, referral and treatment services, as well as outcomes measurement.
