Minority Youth Less Likely to Get Mental Health Care Prior to First Psychosis Episode

By Linda Carroll

December 28, 2020

(Reuters Health) - Black and Hispanic youth are less likely to come to the attention of mental health care providers than white youth prior to a first episode of psychosis, a new study suggests

In an analysis of claims data on 3,017 Black, Hispanic and white youth, researchers determined that prior to a first episode of psychosis, 65.9% of Black and Hispanic youth received behavioral health care as compared to 78.7% of whites, according to the report published in JAMA Psychiatry.

Black and Hispanic youth were also less likely than whites to receive a comorbid behavioral health disorder diagnosis in the year before the psychosis diagnosis: 63.8% versus 76.1%.

“The take home from this study is that for young people who eventually get a diagnosis of psychosis, we’re seeing a much higher rate of outpatient and inpatient care prior to the psychosis in whites compared to Blacks and Hispanics,” said the study’s lead author, Hanke Heun-Johnson, a quantitative analyst at the University of Southern California Leonard D. Schaffer Center for Health Policy and Economics.

Patients who don’t show up on the radar of mental health professionals may be more likely to have worse long term outcomes, Heun-Johnson said, adding that having only claims data limits what can be said about the patients’ long term outcomes.

Heun-Johnson and her colleagues analyzed medical and prescription claims data collected from 2007 to 2015 and stored in Optum’s deidentified Clinformatics Data Mart Database, a commercial claims database that includes information on race and ethnicity as well as socioeconomic variables.

Although the patient records are anonymized, each has a unique identification number that allows researchers to follow patients longitudinally.

Of the 3,017 patients included in the analysis, 343 were Black, 300 were Hispanic and 2,374 were white. The average age of the Black and Hispanic cohort was 17.2, while the average age of the white cohort was 17.0.

In the year before the psychotic event, Black and Hispanic patients were less likely than white patients to visit a behavioral health professional in an outpatient setting (36.1% versus 52.1%) and to receive psychotherapy from a behavioral health professional (30.8% versus 47.9%).

Black and Hispanic youth were also less likely than white youth to receive a behavioral health diagnosis from other outpatient providers -- general practitioners, for example -- in the year before diagnosis (30.9% versus 42.2%).

“I think this is a really awesome article,” said Dr. Ana Radovic, an assistant professor of pediatrics at the University of Pittsburgh School of Medicine and an adolescent medicine specialist at the UPMC Children’s Hospital.

“This study is highlighting the disparities between Black and Hispanic youth and white youth,” Dr. Radovic said. “And what’s really interesting about it is they all had a commercial health plan. Often disparities are attributed to lack of access. Even controlling for factors like lower socioeconomic status they still saw differences in access to treatment.”

It’s important to figure out why these disparities exist, Dr. Radovic said.

“It’s tough to pick up on symptoms early but the earlier you do, the better outcome the patient has,” she added. “So it’s really important to identify young people as early as possible.”

The study can’t explain why the disparities exist, but it’s possible that unconscious biases may be coming in to play, Dr. Radovic said. It’s possible, for example, that some providers see irritability in Black youth—which can be a sign of depression—as aggression, she added.

SOURCE: https://bit.ly/3hoAVfC JAMA Psychiatry, online December 23, 2020.