Denial and its association with mental health care use: a study of island Puerto Ricans.

In clinical practice, denial has long been thought to be a determinant of treatment initiation and retention; however, little empirical research has focused on denial as a mechanism. For example, denial has not been standardized or operationalized in epidemiological studies for mental health services research and, thus, the magnitude of the effects of denial on mental health care use are unknown. This study makes use of the "Mental Health Care among Puerto Ricans" study, a 3-wave island-based probability epidemiological study conducted from 1992 to 1998. For all the 3 waves, 2928 individuals participated (81.5% response). The analyses were limited to only those participants who were objectively determined to have a severe need for mental health care (n = 742). The findings from this study show that admitting to a mental health problem is related to the increased odds of using any mental health care, any specialty care, psychotropic drugs, and retention in mental health care, after adjusting for potential confounding. Similar patterns were observed even after the data were limited to those participants who did not previously seek mental health care, and the trends persisted when determining changes from denial to admitting a mental health problem. The study confirms that denial is a significant factor for treatment initiation and retention, particularly for Puerto Ricans, and denial should be considered an important mechanism in planning interventions to eliminate mental health care disparities.