Gaps in service utilization by Mexican Americans with mental health problems

Objective: The purpose of this study was to ascertain the degree of underut ilization of services for mental health problems among urban and rural Mexi can American adults. Method: A probability sample (N=3,012) was used to rep resent the Mexican American population of Fresno County, California, and fa ce-to-face interviews were conducted with the use of the Composite Internat ional Diagnostic Interview. Bivariate and multivariate analyses were used t o analyze the data on diagnosis and service utilization. Results: Among the respondents with DSM-lll-R-defined disorders, only about one-fourth had us ed a single service or a combination of services in the past 12 months, and Mexican immigrants had a utilization rate which was only two-fifths of tha t of Mexican Americans born in the United States. Overall use of mental hea lth care providers by persons with diagnosed mental disorders was 8.8%, use of providers in the general medical sector was 18.4%, use of other profess ionals was 12.7%, and use of informal providers was only 3.1%. According to logistic regression analyses, factors associated with utilization of menta l health services included female sex, higher educational attainment, unemp loyment, and comorbidity. Conclusions: Immigrants are unlikely to use menta l health services, even when they have a recent disorder, but may use gener al practitioners, which raises questions about the appropriateness, accessi bility, and cost-effectiveness of mental health care for this population. S everal competing hypotheses about the reasons for low utilization of servic es need to be examined in future research.