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Unmet Mental Health Need Among Chinese and Latino Patients in Primary Care

Garcia et al explore the unmet mental health needs of Chinese and Latino patients in primary care settings.

Moushumi Mukerji, MSN, RN, PMHNP-BC, CNM

What do the results of this study mean for a practicing NP?

 “This research sheds light on the role that English language proficiency can play in mental health care disparities among marginalized populations. Primary care providers are uniquely positioned to support the mental health needs of these patients, and they should be aware of the demographic factors."

Though effective treatments for mental health conditions exist, barriers to mental health care continue to exist for ethnic minorities and immigrants and lead to less use of mental health services.1 

Why was the research needed?

Depression and other mental health conditions are increasingly being treated in primary care settings. 1 Previous research has shown that when ethnic minorities and individuals with low English proficiency do seek care, they are more likely to turn to primary care providers than specialty mental health providers. 1, 2 Researchers aimed to study whether the burden of unmet mental health needs among ethnic minorities was reduced through access to primary care and to explore what other factors may be barriers to having these needs addressed.

What did the researchers do?

In this analysis, the researchers examined the prevalence of mental health need among US Chinese and Latino patients seeking primary care, as well as how demographic factors contributed to unmet mental health needs. They interviewed 1149 Chinese and Latino patients within one week of a primary care visit whose preferred language was English, Cantonese, Mandarin, or Spanish.1 Patients were categorized based on gender, ethnicity, and English proficiency (ranked based on language preferences for conducting the interview).

Patient-reported outcomes were perceived mental health need, use of mental health services in the prior year, and unmet mental health need over the course of the previous year. 1 If patients who reported a mental health need did not use services for mental health symptoms, they were categorized as “unmet mental health need”. Regression models were used to analyze the individual and intersectional effects of ethnicity, gender, and English proficiency on outcomes.

What were the main results of the study?

Researchers found a high prevalence of mental health symptoms and unmet mental health needs among Chinese and Latino primary care patients. A total of 33% of participants (n=380) reported mental health need. Of those participants, 41% actually had unmet mental health needs.1

The multivariate analysis found a significant interaction between ethnicity and English proficiency. Among Chinese participants, those with low English proficiency had 2.5 times the odds of reporting mental health need compared to Chinese participants with English proficiency. This effect was not observed among Latino participants. 1

Regardless of ethnicity, men with low English proficiency also had 2.5 times the odds of having unmet mental health needs as men with high English proficiency. This association was not found among women. 1

Researchers noted women, regardless of ethnicity or language proficiency, were more likely to report mental health need in the prior year, though unmet mental health needs were higher among men. 1

Why are these results potentially important?

To the researchers’ knowledge, this study is the first to highlight Chinese and Latino men with low English proficiency as being at higher risk for unmet mental health need. 1 They noted that previous research had examined men and minority populations as being at risk for undertreatment, but the role of low English proficiency was not previously reported. 1

Compared with population-based studies, this study showed higher than expected access and use of mental health care services, researchers noted. 1 They suggest that access to mental health services in primary care may have helped improve the gap in unmet mental health need for Chinese and Latino patients compared with the population-based studies. 1

What’s next?

The findings of this analysis add to available literature on barriers to mental health care access and use among minority patient populations, and the role of English language proficiency in particular.

These results highlight a vulnerable subgroup of patients: men with low English proficiency with unmet mental health needs in the primary care setting.

Researchers suggest that systematic depression screening and interventions in primary care—which have since been implemented at their practice—should be closely tied to the provision of culturally, linguistically, and gender-appropriate services to reduce mental health disparities. 1

Furthermore, they recommend that future research should focus on identifying factors associated with disclosure of symptoms and willingness to engage in mental health care in primary care settings among US Asian and Latino populations, with and without language barriers. 1


This summary was prepared independently of the study’s authors.
  The content presented here is provided for educational purposes only. It is not intended as, nor is it a substitute for medical care or advice. Healthcare professionals should use their clinical judgment when reviewing educational resources on NP Psych Navigator.

References

  1. Garcia M, Hinton L, et al. J Gen Intern Med. 2020; 35(4):1245-1251. doi: 10.1007/s11606-019-05483-9.
  2. Cabassa LJ, Zayas LH, et al. Adm Policy Ment Health. 2006; 33(3): 316–330. doi:10.1007/s10488-006-0040-8.

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