Title:

"Ethnic Disparity in a Co-Occurring Disorders Population"

Principal Investigator:

Vicki A. Nejtek, Ph.D.

Abstract:

The public health significance of co-occurring psychiatric and substance use disorders is of great concern as persons with co-occurring disorders have 12% more outpatient visits and are prescribed three times more psychotropic medications, have 6 times higher hospitalization costs, and 19 times higher mood-related costs than persons with single disorders. Thus, persons with co-occurring disorders are at risk for very poor prognostic outcomes overall. Poor prognosis is increased when persons on limited incomes cannot receive continuity of care and are thus subjected to high levels of life stress. Ethnic groups most at risk for limited incomes and high levels of life stress are African American and Hispanic persons. High rates of psychiatric disorders among African Americans have been associated with socioeconomic disparity and African Americans are two times more likely than Caucasians to seek inpatient rather than outpatient care. Ethnic disparity in health-related services are apparent in persons with co-occurring disorders as increased stress is associated with an increase of psychosomatic complaints more often reported in African American and Hispanic populations than in Caucasians. African American and Hispanic persons with co-occurring disorders are underrepresented in studies investigating health-related treatments, costs, and initiatives. Thus, the relationship between over-or underutilization of health care services and efficacious treatments for co-occurring psychiatric and substance use disorders for minority populations is unknown. Although significant progress has been made in improving the nation's overall health, health disparities among African-Americans and Hispanics in comparison to the general U.S. population continue to exist. African American and Hispanic populations are expected to expand by ~24% over the next decade, especially in Texas (Center for Mental Health, 1998). Thus, examining health disparities among treatment-seeking minority persons with co-occurring disorders is clinically and culturally significant. The long-term goal of this research is to obtain data investigating health disparities among a sample of Caucasian, African American, and Hispanic persons with co-occurring disorders seeking healthcare treatment. Our specific aims are to (1) determine the prevalence of co-occurring psychiatric and substance use disorders among a sample of Caucasian, African American and Hispanic persons seeking health care treatment; (2) examine and compare the prevalence of health disparities and treatment efficacy among ethnic groups in persons with co-occurring disorders; and (3) assess the need for specialized health care versus utilization among ethnic groups. We hypothesize that (1) prevalence rates of psychiatric and substance use disorders will differ among ethnic groups, (2) there will be ethnic differences in psychiatric and addiction treatment efficacy, (3) ethnic groups will differ in their need for specialty health care utilization due to routes of drug administration (i.v. drug use-HIV/AIDS, Hepatitis, etc.), (4) there will be differences in perceived stress levels among ethnic groups related to perceived discrimination, social support, sense of control, and (5) stress severity will be related to frequency of health care utilization and treatment efficacy.

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