NAMHC Concept Clearance •
Pamela Y. Collins, M.D., M.P.H.
Director, Office for Research on Disparities and Global Mental Health
Director, Office of Rural Mental Health Research
This initiative will stimulate research that uses existing data sources to increase knowledge in three areas of mental health disparity research: identification of differences in engagement, outcomes, or mediators for health disparity populations in clinical trials; epidemiology of cardiovascular disease (CVD) risk factors among health disparity populations with serious mental illness (SMI); and methodologies for measuring and tracking mental health disparities.
Disparities in access, availability, and use of mental health services are well-established by race/ethnicity, geography, and socioeconomic status. The inclusion of adequate numbers of children, women, and members of diverse racial and ethnic groups in clinical trials assists in establishing an evidence base for effective mental health interventions for health disparity populations. Yet, published efficacy and effectiveness studies often do not report findings specific to participants from diverse geographic, socioeconomic, or racial/ethnic groups. For example, people with SMI experience elevated rates of mortality, resulting in, on average, a 25 year reduction in longevity, largely due to CVD, compared with the general population in the U.S. While differences in the onset, course, and outcome of CVD by racial/ethnic group membership are well-characterized, less is known about the contribution of racial or ethnic group membership to elevated CVD mortality in the context of SMI. Although the literature on the detection of mental health disparities has been substantially enriched, methodologically rigorous disparities measurements need to be developed that can 1) be easily interpreted by policymakers and 2) track the changes of racial/ethnic, as well as geographic, disparities over time.
This initiative encourages the development of methods to characterize mental health disparities quantitatively; to analyze existing data sets to increase the understanding of the intersecting or additive relationships between SMI, race/ethnicity, and CVD morbidity and mortality; and, to examine factors that may deepen the evidence base for intervention effectiveness in diverse groups.
Scientific areas of interest include:
- Development, testing, and validation of a mental health disparities index or set of indices that take into account assessment of disparities in the domains of race/ethnicity, geography, and socioeconomic status, with attention to specific cultural components that might affect measures of disparities
- Development of preliminary methods for characterizing mental health disparities
- Prevalence and correlates of cardiovascular risk factors for health disparity populations with SMI
- Subgroup analyses of treatment engagement, treatment outcomes, and other mediators of treatment efficacy and effectiveness for diverse groups in intervention studies