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New Study Shows Mental Health Diagnoses and Treatment Vary Significantly by Race and Ethnicity

Findings add to growing body of research that depict disparities in care

April 15, 2016



A woman physician stands in front of a computer writing a prescription to a woman patient sitting in an exam room

PASADENA, Calif. — A large study from Kaiser Permanente, involving more than 7 million adults, found significant differences in the diagnosis and treatment of mental health conditions based on the race and ethnicity of the patients. The new study published in the journal Psychiatric Services, also found that regardless of race or ethnicity, patients were more than twice as likely to receive medication for a mental health condition than formal psychotherapy.

“We studied mental health diagnoses and treatment using electronic health records rather than self-reported survey data from patients and physicians,” said Karen J. Coleman, PhD, study lead author, Kaiser Permanente Southern California, Department of Research & Evaluation. “Our study confirmed previous findings and adds to the growing body of evidence examining diagnosis and treatment of mental health conditions.”

text treatment logo for the Mental Health Research Network. There is a swirl that is like a circle made of several curved lines to the leftResearchers analyzed the electronic medical records of 7.5 million adult patients across 11 health care systems participating in the Mental Health Research Network, a consortium of public-domain research centers. Of these patients, 1.17 million, or 15.6 percent, received a mental health diagnosis in 2011.

The study found that mental health diagnoses varied significantly by race and ethnicity. Native American/Alaskan Native patients had the highest rates of diagnosis (20.6 percent) while Asians had the lowest rates (7.5 percent). In general, the study found that patients from most racial and ethnic minority groups had much lower rates of mental health diagnosis compared to non-Hispanic white patients, ranging from 64 percent lower for Asian patients to 28 percent lower for Hispanic patients.

Diagnosis of specific mental health conditions such as depression and schizophrenia seemed to mirror this overall trend, with some exceptions. Non-Hispanic black patients were nearly twice as likely to be diagnosed with schizophrenia as non-Hispanic white patients. Treatment regimen also differed for non-Hispanic black patients, who were 35 percent less likely to receive medication for their schizophrenia but 2.64 times more likely to receive formal psychotherapy for this condition than their non-Hispanic white counterparts.

Overall, the study found that regardless of racial or ethnic background, patients diagnosed with a mental health condition were more likely to receive medication (73 percent) than to receive formal psychotherapy (34 percent) to treat these conditions.

“While further studies are needed to determine the cause for differences in diagnosis and treatment of mental health conditions based on racial or ethnic background, this study is important in showcasing that disparities exist and provides useful information for health care professionals who treat patients with mental health conditions,” added Coleman.

The patients in the study were enrolled in private, not-for-profit health care organizations that made up the Mental Health Research Network in the year 2011, including Kaiser Permanente (Southern California, Northern California, Hawaii, Colorado and Northwest regions), Group Health Cooperative in Seattle, Baylor Scott & White Health/Central Texas VAMC in Temple, Texas, Henry Ford Health System in Detroit, Harvard Pilgrim Health Care in Boston and HealthPartners in Bloomington, Minnesota.

Funding for this study was provided by the National Institute of Mental Health (U19MH092201).

Other authors of the study include: Christine C. Stewart, PhD, and Greg Simon, MD, from Group Health Research, Seattle; Beth Waitzfelder, PhD, Connie Mah Trinacty, PhD, Nangel M. Lindberg, PhD, and Frances L. Lynch, PhD, from the Center for Health Research, Portland, Oregon; John E. Zeber, PhD, and Laurel A. Copeland, PhD, from the Center for Applied Health Research, Temple, Texas; Leo S. Morales, MD, PhD, from the Center for Equity, Diversity and Inclusion, University of Washington School of Medicine, Seattle; Ameena T. Ahmed, MD, The Permanente Medical Group, Oakland, California; Brian K. Ahmedani, PhD, from the Center for Health Policy & Health Services Research, Detroit; Arne Beck, PhD, Institute for Health Research, Denver; Janet R. Cummings, PhD, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta; Enid M. Hunkeler, MA, FAHA, Division of Research, Oakland, California; Christine Y. Lu, PhD, Department of Population Medicine, Boston; Ashli A. Owen-Smith, PhD, School of Public Health, Georgia State University, Atlanta; Virginia P. Quinn, PhD, Department of Research & Evaluation, Pasadena; Robin R. Whitebird, PhD, HealthPartners Institute for Education and Research, Bloomington, Minnesota.

About the Kaiser Permanente Southern California Department of Research & Evaluation
The Department of Research & Evaluation conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiologic research, health services research, biostatistics research, and behavioral research as well as clinical trials. Major areas of study include chronic disease, infectious disease, cancer, drug safety and effectiveness, and maternal and child health. Headquartered in Pasadena, California, the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general public. Visit kp.org/research.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.