Bridging the gap between common mental disorders and service use: The role of self-rated mental health among African Americans

Objective: The unmet need for mental health care in racial/ethnic minorities has been a major public health concern. Using a sample of African Americans, this study questioned whether self-rated mental health (SRMH), an individual's subjective assessment of personal mental and emotional status, modifies the link between mental disorders and service use. Design: Cross-sectional analyses of the Milwaukee African American over-sample of the Midlife Development in the United States (MIDUS II) study, 2005e2006. Setting: In-home personal interviews. Participants: Self-identified African American/black participants aged 40 to 85 years (N = 460). Measurements: Participants were assessed if they met the diagnostic criteria for three common mental disorders (major depression, generalized anxiety disorder, and panic disorder) in the prior 12 months, using the Composite International Diagnostic Interview (CIDI). Response to a single-item SRMH was dichotomized (excellent/very good/good or fair/poor). Service use was indicated by the use of any services in the past year (mental health specialist, general doctor, and clergy). Results: Multivariate analyses identified a significant interaction between mental disorder and SRMH in predicting service use. The likelihood of service use increased substantially when individuals with a disorder reported their mental health to be fair/poor. Conclusions: Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors. Findings suggest that interventions that enhance an individual's self-awareness of mental health problems may help bridge the gap between mental health care needs and service use in African Americans.