Keywords
Bayesian multilevel modeling; adherence; cross-cultural issues; cultural competence; provider effects; racial-ethnic mental health disparities; treatment adherence
Abstract
Objective: Disparities in diagnosis of mental health problems and in access to treatment among racial-ethnic groups are apparent across different behavioral conditions, particularly in the quality of treatment for depression. This study aimed to determine how much disparities differ across providers.
Methods: Bayesian mixed-effects models were used to estimate whether disparities in patient adherence to antidepressant medication (N=331,776) or psychotherapy (N=275,095) were associated with specific providers. Models also tested whether providers who achieved greater adherence to treatment, on average, among non-Hispanic white patients than among patients from racial-ethnic minority groups attained lower disparities and whether the percentage of patients from racial-ethnic minority groups in a provider caseload was associated with disparities.
Results: Disparities in adherence to both antidepressant medication and psychotherapy were associated with the provider. Provider performance with non-Hispanic white patients was negatively correlated with provider-specific disparities in adherence to psychotherapy but not to antidepressants. A higher proportion of patients from racial-ethnic minority groups in a provider's caseload was associated with lower adherence among non-Hispanic white patients, lower disparities in adherence to psychotherapy, and greater disparities in adherence to antidepressant medication.
Conclusions: Adherence to depression treatment among a provider's patients from racial-ethnic minority groups was related to adherence among that provider's non-Hispanic white patients, but evidence also suggested provider-specific disparities. Efforts among providers to decrease disparities might focus on improving the general skill of providers who treat more patients from racial-ethnic minority groups as well as offering culturally based training to providers with notable disparities.
BYU ScholarsArchive Citation
Baldwin, Scott A.; Merced, Kritzia; Imel, Zac E.; Fischer, Heidi; Yoon, Tae; Stewart, Christine; Simon, Greg; Ahmedani, Brian; Beck, Arne; Daida, Yihe; Hubley, Sam; Rossom, Rebecca; Waitzfelder, Beth; Zeber, John E.; and Coleman, Karen J., "Provider contributions to disparities in mental health care" (2020). Faculty Publications. 6075.
https://scholarsarchive.byu.edu/facpub/6075
Document Type
Peer-Reviewed Article
Publication Date
2020-8
Permanent URL
http://hdl.lib.byu.edu/1877/8804
Language
English
College
Family, Home, and Social Sciences
Department
Psychology