Research is needed about rural mental health services utilization and correlated factors that increase or decrease use of specialty mental health and/or general medical providers. This is especially true for minorities living in rural areas. This application proposes a comprehensive survey of mental health services utilization patterns and related factors in a representative sample (N= 4000) of rural and urban adult Mexican Americans and Mexican origin adults between 18 and 59 years of age who are residing in Fresno County, California. A multi-stage probability sample suitable for comparative analyses would be drawn from eight strata: urban (N=500 men/500 women); small town (N=500 men/500 women); hamlets and isolated rural housing (N=500 men/500 women); and, seasonal migrants (N=500 men/500 women). In addition to a detailed study of utilization patterns across strata, numerous individual-level factors such as psychiatric morbidity assessed using the CIDI, health status, drug use morbidity, SES, cost/financing factors, sociocultural behavior, beliefs and attitudes, acculturation, immigration and occupational histories, and social network characteristics, will be assessed. Environmental/contextual factors will also be studied, and include population density, location of medical and mental health providers, staffing characteristics, referral patterns, configuration of services and outreach, and treatment eligibility requirements. Multivariate analytical techniques will be used to construct descriptive profiles guided by the Help-Seeking Decision-Making Model. Moreover, comparative analyses of lifetime utilization and survival models will be conducted with.the National Comorbidity Survey results.
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