Research has suggested Asian Americans are known to underutilized mental health services [1], [2], [3]. In a national representative sample, Asian Americans were less likely than Caucasians to use prescription drugs for mental illnesses by 23.6 percentage points [1]. Majority of Asian Americans who met criteria for a psychiatric disorder did not use specialty mental health services, and underutilization was particularly prominent among Asian-American immigrants [2]. Among the largest ethnic subgroup, the Chinese Americans, less than 10% of them with mental illnesses sought mental/medical care [3].
For Chinese Americans already receiving outpatient mental health care, frequent premature termination of care often leads to poor outcomes [4]. Le Meyer et al. [2] found that for foreign-born Asian Americans, use of primary care services was unrelated to mental health services use. The current economic downtown has led to cuts in mental health funding, leading to outpatient mental health patients losing their psychiatric services. In an attempt to avoid abrupt psychotropic discontinuation, transitioning these patients to their primary care providers may ensure continuity of care.
We collected data on the prevalence of mental health treatment dropout among a group of Chinese-speaking American clients transitioned from a Los Angeles community mental health center to primary care. There were 25 Chinese-speaking-only psychiatric patients who no longer qualify for specialized outpatient mental health services in the fourth quarter of 2009. All patients were referred back to their own primary care physicians for continuation of psychotropic treatment with a letter indicating discontinuation of psychiatric service. Medication dropout rate was determined by patient self-report. One of the authors (BW) reviewed and abstracted the medical charts of the patients.
Female subjects account for 68.0% (n=17) of the total sample, while 56.0% (n=14) were married. Seventy-two percent (n=18) and 28.0% (n=7) were diagnosed with depressive and anxiety disorders, respectively. All were taking SSRI antidepressants for at least 3 months. For the 18 patients with depressive disorders, the percentage of mild, moderate and severe depression was 28% (n=5), 61% (n=11) and 11% (n=2), respectively. The mean±S.D. for age and years in the US were 45.23±10.78 and 11.2±9.3 years, respectively. All patients identified Cantonese as their primary language, and all had Medicaid as their insurance. Every patient had seen their primary care providers in the past 1 year prior to their mental health clinic termination. However, only three (12.0%) of the 25 patients remained on psychotropic medications 2 months after transitioning to primary care.
We report these findings to shed light on the issue of mental health treatment dropout in an ethnic minority sample. Economic recession can take a toll on governmental agencies, leaving patients without adequate care. Due to their language and cultural barriers, Chinese-speaking-only patients may underutilize mental health services. To lessen such barriers and to foster continuity of care, patients in this sample were referred to their primary care physicians for continuing their psychotropic medication. Particularly troubling was the fact that nearly 90% of the patients in this study stopped taking psychotropic medication after leaving psychiatric care. Future studies should include the perspective of consumers and primary care physicians. It would be important to learn what factors may enhance continuity of psychiatric treatment in primary care setting for Chinese Americans. Without a comparison group, we were not able to determine whether the results indicate ethnic disparities vs. a failure to effectively transfer psychiatric patients to primary care. However, Satre et al. [5] found ethnic disparities in antidepressant use, particularly for Asian-American females. Lastly, studies should further evaluate the cost-effectiveness of behavioral health in primary care for Chinese Americans.
REFERENCES:
[1] Han E., Liu G.G.: Racial disparities in prescription drug use for mental illness among population in US. J Ment Health Policy Econ 8. (3): 131-143.2005; Abstract
[2] Le Meyer O., Zane N., Cho Y.I., et al: Use of specialty mental health services by Asian Americans with psychiatric disorders. J Consult Clin Psychol 77. (5): 1000-1005.2009; Abstract
[3] Young K.N.: Help seeking for emotional/psychological problems among Chinese Americans in the Los Angeles area: an examination of the effects of acculturation, University of California at Los AngelesLos Angeles (CA)1998: 14.
[4] Kung W.: Chinese Americans' help seeking for emotional distress. Soc Serv Rev 77. 110-134.2003;
[5] Satre D.D., Campbell C.I., Gordon N.S., et al: Ethnic disparities in accessing treatment for depression and substance use disorders in an integrated health plan. Int J Psychiatry Med 40. (1): 57-76.2010; Abstract
No comments:
Post a Comment