ArticleHealth services research2011
Crowd-out and exposure effects of physical comorbidities on mental health care use: implications for racial-ethnic disparities in access.
Article in Health services research, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
9 citing papers in PubMed.
- Characterization of multilevel influences of mental health care transitions: a comparative case study analysis.BMC health services research · 2022Article
- Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.International journal of geriatric psychiatry · 2017Article
- Mental Health Disparities Among Low-Income US Hispanic Residents of a US-Mexico Border Colonia.Journal of racial and ethnic health disparities · 2015Article
- Relationship Between General Illness and Mental Health Service Use and Expenditures Among Racially-Ethnically Diverse Adults ≥65 Years.Psychiatric services (Washington, D.C.) · 2015Article
- The costs and benefits of reducing racial-ethnic disparities in mental health care.Psychiatric services (Washington, D.C.) · 2015Article
- Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups.Psychiatric services (Washington, D.C.) · 2014Article
- Racial disparities in the use of cardiac revascularization: does local hospital capacity matter?PloS one · 2013Article
- Measuring racial/ethnic disparities in health care: methods and practical issues.Health services research · 2012Review
- Quality of depression treatment in Black Americans with major depression and comorbid medical illness.General hospital psychiatryArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectivesIn disparities models, researchers adjust for differences in "clinical need," including indicators of comorbidities. We reconsider this practice, assessing (1) if and how having a comorbidity changes the likelihood of recognition and treatment of mental illness; and (2) differences in mental health care disparities estimates with and without adjustment for comorbidities. DATA: Longitudinal data from 2000 to 2007 Medical Expenditure Panel Survey (n=11,083) split into pre and postperiods for white, Latino, and black adults with probable need for mental health care. STUDY
designFirst, we tested a crowd-out effect (comorbidities decrease initiation of mental health care after a primary care provider [PCP] visit) using logistic regression models and an exposure effect (comorbidities cause more PCP visits, increasing initiation of mental health care) using instrumental variable methods. Second, we assessed the impact of adjustment for comorbidities on disparity estimates. PRINCIPAL
findingsWe found no evidence of a crowd-out effect but strong evidence for an exposure effect. Number of postperiod visits positively predicted initiation of mental health care. Adjusting for racial/ethnic differences in comorbidities increased black-white disparities and decreased Latino-white disparities.
conclusionsPositive exposure findings suggest that intensive follow-up programs shown to reduce disparities in chronic-care management may have additional indirect effects on reducing mental health care disparities.
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