The role of primary care in the use of specialty mental health services: an investigation of utilization patterns among African Americans and non-Hispanic Whites

2019-04-25Racial disparities in mental health care in the United States are well documented, particularly with regard to service access, quality of treatment, and treatment outcomes (AHRQ, 2013; Ault-Brutus, 2012; USDHHS, 2001). African Americans are more likely to receive mental health care in primary care settings (Snowden & Pingitore, 2002), where their mental health problems are more likely to go undetected and where they are less likely to receive referrals to specialty care compared to Whites (Borowsky et al., 2000; Lukachko & Olfson, 2012; Miller & McCrone, 2005). Across two studies, we assessed support for three competing hypotheses (i.e., facilitation effect, barriers effect, or inhibition effect) regarding the relationship between primary care and specialty care use for mental health problems. Study 1 tested this relationship in the National Survey of American Life, a national sample of African Americans, and Study 2 replicated this analysis in a second national sample, the National Comorbidity Survey – Replication. Adjusting for covariates and sociodemographic factors in both studies, we found that individuals who used primary care for their mental health needs were less likely to utilize specialty care (Study 1: OR =0.52; 95% CI = 0.35, 0.76; Study 2: OR = 0.21; 95% CI = 0.14, 0.33). Thus, Studies 1 and 2 suggest an inhibition effect of primary care use on specialty care use. Study 2 further examined ethnicity as a moderator of the relationship between primary care and specialty care use, but no effects were found, suggesting a prevalent utilization trend that exists across both ethnic groups. Additional research is warranted to deconstruct the underlying causes of the inhibition effect in order to develop adequate care models that link patients with mental health needs to appropriate care