Utilization of mental health services by minority urban adults: psychosocial predictors

Abstract

Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. A structural equation model controlling for the participants' gender, educational level in emerging adulthood, and age at the most recent data collection showed significant standardized pathways from both ethnicity (β = -0.28; z = -4.82; p < 0.001) and psychological symptoms (β = 0.15; z = 2.41; p < 0.05), both measured in emerging adulthood, to smoking in the early 30s. That, in turn, was associated with certain physical diseases and symptoms (i.e., respiratory) in the mid-30s (β = 0.16; z = 2.59; p < 0.05). These physical diseases and symptoms had a cross-sectional association with family financial difficulty in the mid-30s (β = 0.21; z = 4.53; p < 0.001), which in turn also had a cross-sectional association with psychiatric disorders (β = 0.30; z = 5.30; p < 0.001). Psychiatric disorders had a cross-sectional association with mental health services utilization (β = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.

FIG. 1

Standardized pathways (z-statistic) to mental health service utilization (N = 674). Note 1: CFI = 0.96, RMSEA = 0.06, SRMR = 0.04, χ ² = 138.96, degrees of freedom = 56, p < 0.0001. Note 2: gender, educational level in emerging adulthood, and age in the mid-30s were statistically controlled. Note 3: ethnicity (African Americans = 1, Puerto Ricans = 2). Note 4: mean age and its standard deviation in emerging adulthood (A) = 24.4 (1.3), in the early 30s (B) = 32.2 (1.3), and in the mid-30s (C) = 35.9 (1.4).