Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
Department of Medicine Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
J Affect Disord. 2014 Feb;155:130-7. doi: 10.1016/j.jad.2013.10.037. Epub 2013 Nov 5.
Racial and ethnic minorities in the U.S. underutilize mental health service for mood disorders. This study sought to identify depressive subtypes associated with low use of mental health services across racial and ethnic groups based on a large, nationally representative sample of adults in the U.S.
Based on latent class analysis, we identified the latent profile of depressive symptoms among those who endorsed lifetime depressed mood or anhedonia in the 2001-2002 National Epidemiological Survey on Alcohol and Related Condition (302 Asian Americans; 8602 Whites; 2266 Blacks; 2254 Hispanics). Proportions and types of lifetime mental health service use across depressive symptom subtypes were assessed and compared across the racial and ethnic categories.
A four class model of depressive subtypes was examined across race and ethnicity ("mild," "cognitive," "psychosomatic," and "severe"). Asian Americans, blacks, and Hispanics with "severe" subtype of depression had significantly lower odds of mental health service use compared to whites with "severe" subtype of depression. While Asian Americans did not have higher proportion of "psychosomatic" subtype than other race and ethnic groups, Asian Americans with "cognitive" subtype of depression significantly underused mental health services compared to Asian Americans with "psychosomatic" subtype of depression (Odds ratio:0.34, 95% Confidence interval:0.13,0.91).
We were unable to account for heterogeneity of the subethnic group compositions based on country of origin and other socio-demographic factors.
A targeted outreach intervention to raise awareness among Asian Americans, blacks, and Hispanics with "severe" subtype and Asian Americans with "cognitive" subtype of depression may reduce disparity in mental health service utilization across racial and ethnic groups.
美国的少数族裔和少数民族在情绪障碍方面对心理健康服务的利用率较低。本研究旨在根据美国一项大型全国代表性成年人样本，确定与不同种族和族裔群体心理健康服务利用率低相关的抑郁亚型。
基于潜在类别分析，我们确定了在 2001-2002 年全国酒精相关状况流行病学调查中，那些报告有终生抑郁情绪或快感缺失的个体的抑郁症状潜在模式（302 名亚裔美国人；8602 名白人；2266 名黑人；2254 名西班牙裔美国人）。评估了不同抑郁症状亚型个体的终生心理健康服务使用比例和类型，并在种族和族裔类别之间进行了比较。
跨种族和族裔检验了抑郁亚型的四分类模型（“轻度”、“认知”、“身心”和“重度”）。与白人“重度”抑郁亚型相比，患有“重度”抑郁亚型的亚裔美国人、黑人和西班牙裔美国人使用心理健康服务的可能性显著降低。虽然亚裔美国人“身心”亚型的比例并不高于其他种族和族裔群体，但与“身心”亚型的亚裔美国人相比，患有“认知”亚型的亚裔美国人明显较少使用心理健康服务（优势比：0.34，95%置信区间：0.13，0.91）。
我们无法根据原籍国和其他社会人口因素来解释亚种族群体组成的异质性。
针对亚裔美国人、黑人和西班牙裔“重度”抑郁亚型以及亚裔美国人“认知”抑郁亚型的针对性外展干预措施，可能会减少不同种族和族裔群体在心理健康服务利用方面的差异。
