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标题：Use of Mental Health Services and Subjective Satisfaction With Treatment Among Black Caribbean Immigrants: Results From the National Survey of American Life
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作者：James S. Jackson ; Harold W. Neighbors ; Myriam Torres 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：1
页码：60-67
DOI：10.2105/AJPH.2006.088500
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the use rates and correlates of formal psychiatric services among the US-born and immigrant Caribbean Black population. Methods. We compared overall mental health service use in samples of Caribbean Blacks and African Americans and examined the within-sample ethnic variation among Caribbean Blacks, including for ethnic origin (Spanish Caribbean, Haiti, and English Caribbean), nativity status (those born in or outside the United States), number of years spent living in the United States, age at the time of immigration, and generational status. Results. African Americans and Caribbean Blacks used formal mental health care services at relatively low rates. Among Caribbean Blacks, generational status and nativity showed the greatest effects on rates of reported use, satisfaction, and perceived helpfulness. Of those study participants who met the criteria for disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , about one third used formal mental health care services. The US-born subjects were more likely to receive care than were first-generation immigrants. Conclusions. Our study underscores the importance of ethnicity, immigration, and migration-related factors, within racial categorization, as it pertains to the use of mental health services in the United States. Our findings suggest that timing of migration and generational status of Caribbean Black immigrants and ancestry groups contribute to important differences in rates and sources of use, relative satisfaction, and perception of helpfulness, with regard to formal mental health services. Racial and ethnic disparities in access to mental health care continue to pose significant equity concerns for many population groups in the United States. 1 ^– 3 Data from the Epidemiological Catchment Area and the National Co-morbidity Survey Replication reveal that there is greater unmet need for mental health care among US Blacks and Hispanics than for non-Hispanic White Americans. 4 ^– 6 However, most current publications on use of mental health services lack community epidemiological data on within-race ethnic differences in mental health and use of services. We address this gap with data on immigration and use of mental health services from our recently completed National Survey of American Life (NSAL). The NSAL was a comprehensive study of US Blacks and was unique in that it included representative samples of African Americans and Blacks of Caribbean descent. 7 These data facilitate, for the first time, an investigation of the influences of immigration and ethnicity on use of mental health services among representative national samples of the US Black population. 8 Previous studies of mental health in Black populations have not had large enough sample sizes to investigate within-group ethnic variation. Much of the research to date on immigration and Blacks of Caribbean descent has been conducted in the United Kingdom. 9 ^, 10 There, reports of higher rates of schizophrenia among West Indian versus native White populations began to emerge in 1965, after large-scale migration from the Caribbean during the early 1950s to mid-1960s. 10 Since then, elevated rates of schizophrenia, compared with the general population, have been consistently reported for first- and second-generation Caribbean Blacks. 11 ^– 13 Similarly, in the Netherlands, Caribbean immigrants have rates of schizophrenia that are 3- to 4-times higher than those of the native Dutch population. 14 To test whether these elevated rates were linked to immigration experiences, 3 studies 15 ^– 17 investigated the incidence of first contact with mental health service providers for schizophrenia in Trinidad, Jamaica, and Barbados, and compared those to rates for White populations in the United Kingdom. Rates for citizens living in the 3 Caribbean countries were similar to those for Whites in the United Kingdom, which suggests that the higher rates of schizophrenia for Caribbean Blacks seen in the United Kingdom are the result of immigration and postimmigration experiences. 18 There are also differences between Black Caribbean immigrants and Whites in the use of mental health services. Specifically, Black Caribbean immigrants are less likely to use outpatient services but are overrepresented in institutions when compared with the White population in the United Kingdom. 19 ^– 21 Explanations proposed to explain the relative underuse of outpatient services among Black Caribbean immigrants include language barriers, 22 cultural incompetence on the part of the services staff, 23 ethnocentric stereotyping, 24 and poor previous experiences within the mental health system. 21 ^, 25 Blacks of Caribbean descent are also more likely than White patients to be involuntarily detained under the Mental Health Act of 1983. 25 ^– 27 Detention includes incarceration in both prisons and mental health institutions, which becomes the point of first contact with service providers. 28 In addition, satisfaction levels of mental health care among consumers reveal that Blacks of Caribbean descent had significantly lower satisfaction scores when compared with Whites, 19 ^, 29 ^, 30 especially over time. 29 Our study followed a stress-coping conceptual framework that describes the ways in which the discrepancies between life demands and personal capacities to respond to those demands lead to various strategies to alleviate distress. The variables included in this study’s statistical models were based upon this framework. We focused more specifically on 1 component of that framework: the use of formal mental health services. The stress model is applicable to mental health services research because “going to the doctor” to receive help for a mental disorder is one of the more salient coping responses used by US Blacks; yet paradoxically, despite this relative salience, significant numbers of US Blacks with symptoms of serious mental health disorders do not seek treatment. Consequently, there is potential for increasing access to mental health care for US Blacks by examining the complex relationships among the variables chosen for inclusion in the statistical models. Our previous work used this framework to build upon national samples that were not ethnically diverse and raised questions about the uniqueness of the US Black mental health experience and the meaning of such seemingly simple terms as “race” and “ethnicity.” 31 ^, 32 As a result, the stress model was expanded in the NSAL to include additional measures, such as migration and generational status. In previous analyses, 33 these measures were shown to provide additional context and a deeper meaning to the simplistic population group comparisons that seem to dominate much of the racial disparities research landscape. Very little is known about use of mental health services by Blacks of Caribbean descent in the United States. As noted previously, practically all that is known about this population is from studies conducted in the United Kingdom. Our review of the available literature did not uncover any studies comparing use of mental health services by Blacks of Caribbean descent to other population groups in the United States. Our study is the first to examine within-race ethnic differences in use of mental health services and correlates within a US population sample similar to those examined in the United Kingdom. Specifically, we examined formal service use among national probability samples of Caribbean Black and African American adults. We were especially interested in ethnic variation, nativity, age at time of immigration, years spent in the United States, and generational status differences in formal mental health services use within the Caribbean Black sample.