Skip to main content

Advertisement

Log in

Ethnic Differences in Perceived Impairment and Need for Care

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Alegría, M., & McGuire, T. (2003). Rethinking a universal framework in the psychiatric symptom-disorder relationship. Journal of Health and Social Behavior, 44(3), 257–274.

    Article  PubMed  Google Scholar 

  • Alegría, M., Canino, G., Lai, S., Ramirez, R. R., Chavez, L., Rusch, D., et al. (2004). Understanding caregivers' help-seeking for Latino children's mental health care use. Medical Care, 42(5), 447–455.

    Article  PubMed  Google Scholar 

  • Alegría, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A., et al. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Medical Care, 46(3), 247–256.

    Article  PubMed  Google Scholar 

  • Bird, H. R., Andrews, H., Schwab-Stone, M., Goodman, S., Dulcan, M., Richters, J., et al. (1996). Global measures of impairment for epidemiologic and clinical use with children and adolescents. International Journal of Methods in Psychiatric Research, 6, 295–307.

    Article  Google Scholar 

  • Bird, H. R., Canino, G. J., Davies, M., Zhang, H., Ramirez, R., & Lahey, B. B. (2001). Prevalence and correlates of antisocial behaviors among three ethnic groups. Journal of Abnormal Child Psychology, 29(6), 465–478.

    Article  PubMed  Google Scholar 

  • Cabiya, J. J., Canino, G., Chavez, L., Ramirez, R., Alegria, M., Shrout, P., et al. (2006). Gender disparities in mental health service use of Puerto Rican children and adolescents. Journal of Child Psychology and Psychiatry, 47(8), 840–848.

    Article  PubMed  Google Scholar 

  • Canino, G., & Bravo, M. (1994). The adaptation and testing of diagnostic and outcome measures for cross-cultural research. International Review of Psychiatry, 6, 281–286.

    Article  Google Scholar 

  • Canino, G., & Roberts, R. E. (2001). Suicidal behavior among Latino youth. Suicide and Life-Threatening Behavior, 31(Suppl), 122–131.

    Article  PubMed  Google Scholar 

  • Canino, G., Shrout, P. E., Rubio-Stipec, M., Bird, H. R., Bravo, M., Ramirez, R., et al. (2004). The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Archives of General Psychiatry, 61(1), 85–93.

    Article  PubMed  Google Scholar 

  • Chang, D. F., & Sue, S. (2003). The effects of race and problem type on teachers' assessments of student behavior. Journal of Consulting and Clinical Psychology, 71(2), 235–242.

    Article  PubMed  Google Scholar 

  • Chen, M., & Bargh, J. A. (1997). Nonconscious behavioral confirmation processes: the self-fulfilling nature of automatically-activated stereotypes. Journal of Experimental Social Psychology, 33, 541–560.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

  • Cohen, P., & Cohen, J. (1984). The clinician's illusion. Archives of General Psychiatry, 41(12), 1178–1182.

    PubMed  Google Scholar 

  • Devine, P. G. (2001). Implicit prejudice and stereotyping: how automatic are they? Introduction to the special section. Journal of Personality and Social Psychology, 81(5), 757–759.

    Article  PubMed  Google Scholar 

  • Diggle, P. J., Liang, K. Y., & Zeger, S. L. (1994). Analysis of Longitudinal Data. Oxford University Press.

  • Dworkin, R. J., & Adams, G. L. (1987). Retention of Hispanics in public sector mental health services. Community Ment Health J, 23(3), 204–216.

    Article  PubMed  Google Scholar 

  • Essau, C. A., Conradt, J., & Petermann, F. (2002). Course and outcome of anxiety disorders in adolescents. Journal of Anxiety Disorders, 16(1), 67–81.

    Article  PubMed  Google Scholar 

  • Flisher, A. J., Kramer, R. A., Grosser, R. C., Alegria, M., Bird, H. R., Bourdon, K. H., et al. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27(5), 1145–1154.

    Article  PubMed  Google Scholar 

  • Garland, A. F., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L., & Landsverk, J. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), 1336–1343.

    Article  PubMed  Google Scholar 

  • Goodman, S. H., Schwab-Stone, M., Lahey, B. B., Shaffer, D., & Jensen, P. S. (2000). Major depression and dysthymia in children and adolescents: discriminant validity and differential consequences in a community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 39(6), 761–770.

    Article  PubMed  Google Scholar 

  • Green, M. T., Clopton, J. R., & Pope, A. W. (1996). Understanding gender differences in referral of children to mental health services. Journal of Emotional and Behavioral Disorders, 4(3), 182–190.

    Article  Google Scholar 

  • Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., et al. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine, 22(9), 1231–1238.

    Article  PubMed  Google Scholar 

  • Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychology Review, 102(1), 4–27.

    Article  Google Scholar 

  • Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in implicit cognition: the implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480.

    Article  PubMed  Google Scholar 

  • Gudiño, O. G., Lau, A. S., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services. Journal of Emotional and Behavioral Disorders, 17(1), 3–16.

    Article  Google Scholar 

  • Horwitz, S. M., Leaf, P. J., Leventhal, J. M., Forsyth, B., & Speechley, K. N. (1992). Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics, 89(3), 480–485.

    PubMed  Google Scholar 

  • Hough, R. L., Hazen, A. L., Soriano, F. I., Wood, P., McCabe, K., & Yeh, M. (2002). Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services, 53(12), 1556–1562.

    Article  PubMed  Google Scholar 

  • Jones, T. V., Gerrity, M. S., & Earp, J. (1990). Written case simulations: do they predict physicians' behavior? Journal of Clinical Epidemiology, 43(8), 805–815.

    Article  PubMed  Google Scholar 

  • Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.

    Article  PubMed  Google Scholar 

  • Kirwan, J. R., Chaput de Saintonge, D. M., Joyce, C. R., & Currey, H. L. (1983a). Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'. Annals of Rheumatic Diseases, 42(6), 644–647.

    Article  Google Scholar 

  • Kirwan, J. R., Chaput de Saintonge, D. M., Joyce, C. R., & Currey, H. L. (1983b). Clinical judgment in rheumatoid arthritis. II. Judging 'current disease activity' in clinical practice. Annals of Rheumatic Diseases, 42(6), 648–651.

    Article  Google Scholar 

  • Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, C. W., et al. (1996). Mental health service use in the community and schools: results from the four-community MECA study. Methods for the epidemiology of child and adolescent mental disorders study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 889–897.

    Article  PubMed  Google Scholar 

  • Lopez, S. R. (1989). Patient variable biases in clinical judgment: conceptual overview and methodological considerations. Psychological Bulletin, 106(2), 184–203.

    Article  PubMed  Google Scholar 

  • Masi, R., Cooper, J. L. (2006). Children’s mental health: Facts for policymakers. National Center for Children in Poverty, Columbia University Mailman School of Public Health.

  • Matias-Carrelo, L. E., Chavez, L. M., Negron, G., Canino, G., Aguilar-Gaxiola, S., & Hoppe, S. (2003). The Spanish translation and cultural adaptation of five mental health outcome measures. Culture, Medicine, and Psychiatry, 27(3), 291–313.

    Article  Google Scholar 

  • Neighbors, H. W., Trierweiler, S. J., Ford, B. C., & Muroff, J. R. (2003). Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans. Journal of Health and Social Behavior, 44(3), 237–256.

    Article  PubMed  Google Scholar 

  • Rivadeneyra, R., Ward, L. M., & Gordon, M. (2007). Distorted reflections: media exposure and latino adolescents’ conceptions of self. Media Psychology, 9, 261–290.

    Google Scholar 

  • Roberts, R. E. (2000). Depression and suicidal behaviors among adolescents: the role of ethnicity. In I. Cuellar & F. H. Paniagua (Eds.), Handbook of multi-cultural mental health (pp. 360–380). San Diego: Academic.

    Google Scholar 

  • Roberts, R. E., Alegría, M., Roberts, C. R., & Chen, I. G. (2005a). Mental health problems of adolescents as reported by their caregivers: a comparison of European, African, and Latino Americans. Journal of Behavioral Health Services and Research, 32(1), 1–13.

    Article  PubMed  Google Scholar 

  • Roberts, R. E., Alegría, M., Roberts, C. R., & Chen, I. G. (2005b). Concordance of reports of mental health functioning by adolescents and their caregivers: a comparison of European, African and Latino Americans. Journal of Nervous and Mental Disease, 193(8), 528–534.

    Article  PubMed  Google Scholar 

  • Roberts, R. E., Roberts, C. R., & Xing, Y. (2006). Prevalence of youth-reported DSM-IV psychiatric disorders among African, European, and Mexican American adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1329–1337.

    Article  PubMed  Google Scholar 

  • SAS Institute, Inc. (2003). Version 9.1. Cary: SAS.

    Google Scholar 

  • Schulman, G. I., & Hammer, J. (1988). Social characteristics, the diagnosis of mental disorders, and the change from DSM II to DSM III. Sociology of Health & Illness, 10(4), 543–560.

    Article  Google Scholar 

  • Schulman, K. A., Ohishi, A., Park, J., Glick, H. A., & Eisenberg, J. M. (1999). Clinical economics in clinical trials: the measurement of cost and outcomes in the assessment of clinical services through clinical trials. Keio Journal of Medicine, 48(1), 1–11.

    PubMed  Google Scholar 

  • Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.

    PubMed  Google Scholar 

  • Slade, E. P. (2004). Racial/ethnic disparities in parent perception of child need for mental health care following school disciplinary events. Mental Health Services and Research, 6(2), 75–92.

    Article  Google Scholar 

  • Snowden, L. R. (2003). Bias in mental health assessment and intervention: theory and evidence. American Journal of Public Health, 93(2), 239–243.

    Article  PubMed  Google Scholar 

  • Twenge, J. M., & Nolen-Hoeksema, S. (2002). Age, gender, race, socioeconomic status, and birth cohort differences on the children's depression inventory: a meta-analysis. Journal of Abnormal Psychology, 111(4), 578–588.

    Article  PubMed  Google Scholar 

  • Wu, P., Hoven, C. W., Cohen, P., Liu, X., Moore, R. E., Tiet, Q., et al. (2001). Factors associated with use of mental health services for depression by children and adolescents. Psychiatric Services, 52(2), 189–195.

    Article  PubMed  Google Scholar 

  • Yeh, M., McCabe, K., Hough, R. L., Dupuis, D., & Hazen, A. (2003). Racial/ethnic differences in parental endorsement of barriers to mental health services for youth. Mental Health and Services Research, 5(2), 65–77.

    Article  Google Scholar 

  • Zwaanswijk, M., Van der Ende, J., Verhaak, P. F., Bensing, J. M., & Verhulst, F. C. (2003). Factors associated with adolescent mental health service need and utilization. Journal of the American Academy of Child and Adolescent Psychiatry, 42(6), 692–700.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors wish to thank Tom McGuire, Ph.D. for his thoughtful comments on drafts of this document. We would like to express our gratitude to Silvia Gosnell, JD, Ph.D, Lisa Fortuna, M.D., Nick Carson, M.D., Adrianne Anderson, Mariam O’Neal and Yaminette Diaz for their valuable collaboration and support in data collection and implementation of this study, as well as other collaborating clinicians at both CHA and the Department of Psychiatry, University of Puerto Rico.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ligia M. Chavez.

Additional information

This study was supported by NIH Research Grant # P50 MHO 73469-01 funded by the National Institute of Mental Health, and # P60 MDO 02261 (NCMHD) funded by the National Center for Minority Health and Health Disparities.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chavez, L.M., Shrout, P.E., Alegría, M. et al. Ethnic Differences in Perceived Impairment and Need for Care. J Abnorm Child Psychol 38, 1165–1177 (2010). https://doi.org/10.1007/s10802-010-9428-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-010-9428-8

Keywords

Navigation