The mechanisms that generate racial/ethnic disparities in health care operate at two levels: the healthcare system, and the clinical encounter. This application proposes to conduct research on the mechanisms that lead to racial/ethnic disparities in mental health services. Disparities, defined formally in the application, are essentially unjustified differences in the rates of use of health care services across groups. Recent theoretical and conceptual research provides the frameworks for empirical analyses of the reasons behind disparities. This application proposes to apply and test these frameworks for the purposes of informing policy about effective actions to combat disparities. We bring together a multidisciplinary team to conduct a series of integrated empirical and policy studies using previously collected data. The proposed research capitalizes on NIMH investments in data with large numbers of members of racial and ethnic minorities to make progress on understanding and reducing mental health care disparities.
The specific aims of the application are: Operationalize the recently proposed Institute of Medicine definition of disparities using a large national data set to distinguish among Differences, Disparities and Discrimination when comparing mental health care for minority and majority populations. Quantify disparities in mental health, and identify the role of system factors and discrimination in mental health services disparities. Compare mental health care use by African Americans, Asian Americans and Latinos with use by Whites. Investigate provider-side mechanisms explaining discrimination in the clinical encounter using data from the Quality Improvement for Depression (QID) projects. Test whether """"""""statistical discrimination"""""""" can account for some of racial/ethnic differences in diagnosis and treatment recommendations for African-American and Latino populations. Test for evidence that patient reaction to provider discrimination leads to lower compliance rates and worse outcomes for these minorities. ? ?
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