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Race-Ethnicity and Diagnosis as Predictors of Outpatient Service Use Among Treatment Initiators

Dr. Elwy and Dr. Eisen are with the Center for Health Quality, Outcomes, and Economic Research, Department of Veterans Affairs, 200 Springs Rd., Mail Stop 152, Bedford, MA 01730 (e-mail: relwy{at}bu.edu). They are also with the Department of Health Policy and Management and Ms. Ranganathan is with the Department of Biostatistics, both at Boston University School of Public Health.

OBJECTIVE: This study examined the relationship between race-ethnicity, psychiatric and substance abuse symptoms and diagnoses, and number of outpatient visits for mental health or substance abuse problems in the two months after intake. Data were examined from clients who had an initial intake visit at one of 12 outpatient mental health or substance abuse treatment sites in each of the four U.S. census regions. METHODS: The sample included 1,899 patients with a new intake to outpatient mental health or substance abuse programs between May 2001 and June 2002. Demographic characteristics and symptom and problem difficulty, including alcohol or drug use, were assessed at intake with the revised 24-item Behavior and Symptom Identification Scale (BASIS-24) as part of a continuous quality improvement program. DSM-IV diagnoses and number of outpatient visits in the two-month period after intake were extracted from medical records or administrative databases. RESULTS: Diagnoses were available for 1,807 patients. Non-Latino black clients and Latino clients reported worse symptoms of psychiatric disorders and substance use disorders at intake than non-Latino white clients, but race-ethnicity was not associated with the number of outpatient visits. Having a diagnosis of a substance use disorder, alone or with another mental disorder, and baseline symptom severity were associated with a greater number of outpatient treatment visits in the two months after intake. CONCLUSIONS: This study did not find racial or ethnic disparities in service use among clients who had already initiated outpatient mental health or substance abuse treatment. These findings suggest that racial and ethnic disparities in mental health care may be due to treatment-seeking rates, that more emphasis should be placed on ensuring that treatment is available and accessible, and that those who need treatment are activated to initiate it.

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