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Race, Psychiatric Diagnosis, and Mental Health Care Utilization in Older Patients

Received May 18, 1999; revised October 28, 1999; accepted December 3, 1999. From the Geriatric Research, Education, and Clinical Center, Ann Arbor Veterans Affairs Medical Center; the Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Health Services Research and Development Service, Ann Arbor VA Medical Center; the Psychiatry Service, Ann Arbor VA Medical Center, and the Division of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan. Address correspondence to Dr. Kales, Psychiatry Service (116A), Ann Arbor VA Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105. e-mail: kales{at}umich.edu

To evaluate the impact of race on mental health care utilization among older patients within given clinical psychiatric diagnoses, the authors examined a retrospective sample of 23,718 elderly veterans treated in Department of Veterans Affairs inpatient facilities in 1994. Significant racial differences in mental health care utilization found over a subsequent 2-year period were related to outpatient (but not inpatient) care; for instance: 1) African American patients with psychotic disorders had significantly fewer outpatient psychiatric visits; and 2) African American patients with substance abuse disorders had significantly more psychiatric visits than Caucasian patients in their respective groups. Although inpatient utilization appeared to be similar among races, findings related to outpatient utilization may be associated with such factors as compliance, treatment efficacy, access to health care, or possible clinician bias.

Key Words: Minority Issues • Diagnostic Criteria • Health Services

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