Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health

Abstract

Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health.

Fig. 1

Weighted relative risk ratios for type of mental health care professional by residential segregation. Source: Medical Expenditure Panel Survey (MEPS) HC-105: 2006 Full Year; 2000 Census; 2006 AMAARF. Note: Lat = Latino, AfAm = African American, Predom = Predominant. All models control for age, sex, health insurance, income, percent owner occupied housing units, percent renter occupied housing units and K(6). Significance at *p ≤ .05, **p ≤ .01, ***p ≤ .001.