VCU news

By Brian McNeill

Older African Americans living in U.S. counties with a higher population of Black residents are less likely to pursue mental health treatment, according to a study led by a Virginia Commonwealth University School of Social Work professor.

The findings of the study, “The Role of County Characteristics in Mental Health Service Use by Older African Americans,” suggest that policymakers interested in reducing racial disparities in mental health care could target programs for older African Americans in geographic areas with a higher percentage of African American residents.

“We know that racial and ethnic disparities in mental health and mental health care exist,” said lead author Kyeongmo Kim, Ph.D., an assistant professor in the School of Social Work. “Research showed that racial and ethnic minorities are less likely to use mental health services although they had similar mental health conditions or disorders. Beyond racial [and] ethnic group differences, we wanted to find out whether a within-group difference existed. Particularly, older African Americans have been historically discriminated against in the labor and housing market. As a result, they were less likely to get quality mental health care.”

Previous research has found that older African Americans are less likely to seek mental health services, even though they experience mental health problems at rates similar to older white people. Untreated mental disorders are associated with an increased risk of morbidity and mortality and lower quality of life. So researchers are keenly interested in understanding factors that influence these racial disparities in mental health care.

Kim’s study was first published in the journal Psychiatric Services in May and reprinted in January as  part of an editor’s collection on racial and ethnic mental health disparities. It explores how mental health services use among older African Americans is shaped by the environment, particularly the characteristics of the counties in which they reside. It focuses on counties because they are generally the smallest administrative unit used for planning and providing social and health care services.

“It is important to understand the effect of geography because accessing mental health care occurs in the community that people live in,” Kim said. “Depending on where you live, you may not have an appropriate source of care or may not receive quality services. It will help figure out contributing factors to ongoing mental health disparities.”

The study did not find an explanation for why older African Americans living in areas with a higher population of Black residents were less likely to pursue mental health care. However, it does put forward several possible contributing factors.

For one, older African American adults are more likely to live in disadvantaged areas with limited access to mental health care, possibly resulting in lower service utilization. Also, mental health professionals may avoid providing services in neighborhoods with lower socioeconomic status, raising questions about the role of mental health provider attitudes and biases.

The study also suggests that older African Americans living in counties with a higher percentage of African Americans may be less likely to seek out mental health care because of historical and contemporaneous discrimination by the health care system and mistrust of medical professionals.

“Also, a limited mental health workforce may contribute to less use of mental health services,” Kim said. “Only about 2% of mental health professionals are Black. Research shows that older African Americans had barriers to accessing mental health care and wanted to see a culturally competent mental health professional.”

Yet another possible explanation is that older African Americans may be more likely to discuss concerns with clergy or church members, rather than through mental health treatment, Kim said.

The study adds to a growing body of research that examines the effect of racial segregation on mental health care.

“A neighborhood with a higher percentage of African Americans can be a disproportionately affected area by racial and residential segregation that limits educational and economic opportunity,” Kim said. “Building on this study, I am working on examining the mechanism of how racial segregation affects mental health care of older racial and ethnic minorities.”

In addition to Kim, the study also involved co-authors Amanda J. Lehning, Ph.D., and Paul Sacco, Ph.D., both associate professors at the University of Maryland School of Social Work.