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Research to Support the Reduction and Elimination of Mental Health Disparities

NAMHC Concept Clearance

Presenter:

Charlene E. Le Fauve, Ph.D.,
Office for Research on Disparities and Global Mental Health

Goal:

The goal of this initiative is to foster research across the NIMH Strategic Objectives that targets the reduction and elimination of mental health disparities among racial and ethnic groups in the United States. This initiative aims to fill an important gap in clarifying mechanisms underlying disparities or differences in mental health status as well as optimal delivery of mental health interventions among diverse racial and ethnic groups.

Rationale:

Racial and ethnic minorities tend to have more severe, persistent, and disabling mental disorders,1 though they generally have lower prevalence of mental disorders than whites.2,3 Racial and ethnic minorities, however, are less likely to access mental health services,4 less likely to receive quality mental health care,5 and more likely to have poorer mental health outcomes.6

This initiative aims to support research that satisfies priorities in the mental health disparities program.  These priorities include: 1) increasing the understanding of mechanisms underlying disparities and differences in mental health status through the study of diverse racial and ethnic groups, 2) scaling evidence-based interventions to reduce disparities, and 3) reducing disparities in access to, quality of, and outcomes of care.

Areas of research relevant to priorities in the mental health disparities program:

  • Application of unbiased genomic approaches to assess genetic risk contribution to mental disorders across diverse racial and ethnic groups from different ancestries.
  • Identification of early biological and environmental risk and protective factors associated with mental health and their underlying mechanisms to serve as potential novel targets for treatment or preventive intervention among diverse groups.
  • Examination and assessment of community engagement, adherence, and retention strategies designed or modified for culturally diverse populations.
  • Comprehension, prediction, and manipulation of factors that mediate or moderate effectiveness of interventions that increase access, quality, and scalability of mental health services among diverse underserved groups.
  • Elucidation of reasons for disparities and/or new trends among racial and ethnic groups in suicide burden (ideation, attempts, deaths), and potential contributors to suicide risk and/or protective factors.

Portfolio analyses of Minority Health and Health Disparities grants suggest the need for additional recruitment, data collection, and/or analyses of data from underserved racial/ethnic populations, especially American Indians/Alaska Natives, Asians, Pacific Islanders, immigrants and refugees, and sub-ethnic groups (e.g., Black Caribbean, Chinese, Haitian, Korean, Puerto Rican, South Asian, etc.). The field of mental health disparities research would be bolstered by greater recruitment of racial and ethnic minorities in all genomics, translational, efficacy, effectiveness, and implementation research to detect and understand group differences. Psychotic disorders, bipolar disorder, autism, and suicide among racial and ethnic minorities are categories that would benefit from greater representation in the portfolio.

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References:

1 Cohen, C. I., & Marino, L. (2013). Racial and ethnic differences in the prevalence of psychotic symptoms in the general population. Psychiatr Serv, 64(11), 1103-1109. doi:10.1176/appi.ps.201200348

2 Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. doi: 10.1001/archpsyc.62.6.593

3 Takeuchi, D. T., Hong, S., Gile, K., & Alegría, M. (2007). Developmental contexts and mental disorders among Asian Americans. Research in Human Development, 4(1-2), 49-69. doi: 10.1080/15427600701480998

4 Substance Abuse and Mental Health Services Administration, Racial/Ethnic Differences in Mental Health Service Use among Adults. HHS Publication No. SMA-15-4906. Rockville, MD: SAMHSA 2015

5 Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C.-n., Takeuchi, D., et al. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264-1272. doi: 10.1176/appi.ps.59.11.1264

6 McGuire, T. G., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Affairs, 27(2), 393-403. doi:10.1377/hlthaff.27.2.393