Key points to remember
- New report reveals discrepancies in mental health diagnoses in the United States
- Asian patients, in particular, were much less likely to be diagnosed with depression or anxiety than white patients.
- Experts say these trends highlight barriers to caring for people of color.
The diagnosis of anxiety or depression during a primary care visit may not depend solely on your mental health condition. New Analysis Finds Large Disparities In Getting A Mental Health Diagnosis Across Races And Ethnicities In The United Statessese
An Athenahealth analysis of patient visits to primary care providers (PCP) in 2020 found that although anxiety and depression are “strikingly” in more than 24 million patients, the diagnosis of conditions varied widely between patients. demographic groups.
Many experts say this data points to underlying disparities in mental health care in the United States. After all, a patient is diagnosed with a disorder when they feel comfortable or able to express their mental health symptoms with a PCP.
Overall, white patients were more likely to discuss their mental health with PCPs, and therefore receive a diagnosis if needed, than those of all other racial groups. The gap for Asian patients was particularly wide: they were 227% and 213% less likely to be diagnosed with anxiety or depression, respectively, than whites.
“We cannot examine racial disparities without recognizing that our country’s systems were built to serve the white majority, and the healthcare system is no exception,” Kelly Yang, BS, medical student and researcher at Albert Einstein College of Medicine in New York, says Verywell. She adds that factors such as stigma and the lack of Black, Indigenous and Colored (BIPOC) healthcare professionals perpetuate these inequalities.
How Race and Ethnicity Impact Your Health Care
The Athenahealth study followed more than 24 million people over an 8-month period, between May and December of last year. Patients were considered to be suffering from anxiety or depression if at least one PCP visit led to a diagnosis. Demographic trends in the diagnosis of depression and anxiety disorders included:
- Women were more than one and a half times more likely than men to be diagnosed with anxiety disorder or major depression
- Patients aged 51 to 70 were the most likely to be diagnosed with anxiety
- Patients aged 71 to 80 were the most likely to be diagnosed with depression
- The more chronic health conditions you had, the more likely you were to be diagnosed with either of these conditions.sese
The research was inspired by a Center for Disease Control and Prevention (CDC) investigative report conducted in June 2020. The CDC found that American adults suffered from more anxiety and depression during the pandemic, compared to younger adults. and Hispanic / Latino people feeling the brunt of it.sese
Trends in gender, age, and medical history can be at least partially explained by existing evidence. For example, women, in general, are more likely to talk about mental health issues with their PCP and to seek help.
But racial and ethnic trends highlight barriers to care. In the study, white patients were significantly more likely to be diagnosed with depression or anxiety than black, Hispanic / Latino and especially Asian patients.
Compared to Asians, in particular, 7.2% and 4.7% of white patients were diagnosed with anxiety and depression, respectively. In comparison, Asian patients were only diagnosed at rates of 2.2% and 1.5%.
Disparities in mental health care in Asia
When considering these rates, some might assume that Asian patients just don’t struggle as much with depression and anxiety. But that’s far from the reality, says Yang.
In a 2019 study, Yang and her colleagues found that while Asians and whites may perceive their need for mental health care at different rates, this does not explain the large gap between those diagnosed and treated.seConcretely :
- 87.1% of White respondents with a perceived need for mental health care received it, compared to 80% of Asians with a perceived need
- 53.3% of Whites reporting severe psychological distress received mental health treatment versus 28.9% of Asians reporting the same distress
- 70% of white patients with a major depressive episode in the past year received mental health treatment, compared to 35.3% of their Asian counterparts
Why are Asian respondent rates consistently lower? When Yang and her colleagues asked Asian respondents about their care, they cited not knowing where to go for treatment more often than white people.
And while cost has not been reported as a significant barrier to treatment, additional evidence suggests otherwise. “The high cost of mental health care in the United States remains a challenge faced by many people seeking care, and which disproportionately affects people of color, including Asian Americans,” adds Yang.
“Much of the literature cites stigma as a major contributor to the disparity in mental health care,” Yang adds. “While this is certainly a contributing factor, there are by far systemic factors that contribute to the lack of treatment in mental health.”
The experience of a supplier
Timothy Lo, LCSW, psychotherapist in Chicago, says the Athenahealth report helps contextualize long-term issues. “The question is, do Asian Americans get diagnosed at a higher or lower rate depending on who they are, or what system they are part of?”
Lo says the answer is the last. Yang’s study, he adds, further contextualizes the issues. “Part of this is just the use, which Asian Americans are less likely to ask for help even though they know it’s there, even if they need it.”
In general, this corresponds to his anecdotal experience as a clinician. “In Asian populations, like most immigrant populations in the United States, access to mental health services is more stigmatized,” he says. Among his Asian clients, he sees a lack of recognition around the topic of mental health, especially among immigrants who did not grow up in the United States.
There may also be a language barrier, as a minority of therapists speak Cantonese or Mandarin. “This has occurred to me on several occasions, where people have contacted me because they are desperately trying to find a therapist for themselves or family members who actually want to use the services, but their English is not there. not good enough, ”he said. said. “I can not talk [their language] almost well enough to do clinical work.
And in general, among the Asian customers he sees, they tend to seek him out through insurance. People who do not have or cannot afford insurance cannot find help this way.
How to address these disparities
Mental health care in the United States has been and does not take cultural or language differences into account, Yang says, because the majority of mental health personnel are white individuals.
But that doesn’t mean it can’t change. “The health field is moving in the right direction as cultural competence is now strongly emphasized, more and more individuals from racial / ethnic minorities are entering mental health staff and efforts such as Project All of Us are in the process of including more diverse samples of research study participants, ”Yang says. “However, we still have a long way to go before any form of fairness can be achieved.”
When considering what needs to change to reduce disparities, Lo says it starts with access. Everyone who needs to access care should get it, removing all barriers including lack of multicultural providers, cost, planning and location. “It would mean a huge change in multiple ways across the mental health field,” he says. It would also involve universal health care, he adds.
In an ideal world, Yang says, the United States would achieve mental health equity, not just equality, by establishing a system where everyone gets what they specifically need to live healthy, fulfilling lives. “This includes not only access to mental health care, but also to food, shelter, work and other basic human needs that inevitably impact our mental health,” she says.