Relations Among Race/Ethnicity, Gender, and Mental Health Status in Primary Care Use

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Objective: Many working-age individuals with a serious mental health disability go without primary care. Gender and racial/ethnic disparities have been found in primary care utilization. This article examines whether the interaction of gender and race/ethnicity with serious mental health disability is associated with primary care use among working-age individuals. Method: We pooled data from the Medical Expenditure Panel Survey—Household Component (MEPS-HC) panels for the years 2001 to 2007 creating a sample of 34,199 individuals, 1,605 of whom had serious mental health disability. MEPS-HC is a nationally representative survey of the civilian noninstitutionalized population of the United States. We defined serious mental health disability as having scored less than 30 on the Mental Health Composite Score of the Short Form 12. Primary care visits were defined as nonspecialty, nonemergency visits to a physician’s office or clinic. Zero-inflated Poisson regression models and bootstrapped predictive margins of visits were estimated using weights to account for survey design. Results: Relative to women, men with serious mental health disability had significantly more primary care visits and lower log odds of “zero” visits—the opposite pattern was found for people without serious mental health disability. We did not find a significant interaction between race/ethnicity and serious mental health disability. Conclusion and Implications for Practice: Serious mental health disability appears to have differing impacts on men and women’s use of primary care. There is a continued need to understand what differentiates users from nonusers among adults with serious mental health disability and the relative contribution of patient, provider, and system factors.

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