Distress, Impairment, and Racial/Ethnic Differences in Perceived Need for Mental Health Treatment in a Nationally Representative Sample

Published in: Psychiatry: Interpersonal and Biological Processes, Volume 83, Issue 2, pages 149–160 (2020). doi: 10.1080/00332747.2020.1762394

Posted on RAND.org on December 16, 2020

by Joshua Breslau, Eunice C. Wong, M. Audrey Burnam, Ryan K. McBain, Matthew Cefalu, Robin L. Beckman, Rebecca L. Collins

Read More

Access further information on this document at Psychiatry: Interpersonal and Biological Processes

This article was published outside of RAND. The full text of the article can be found at the link above.


To advance our understanding of racial/ethnic differences in help seeking for mental health conditions, this article tests whether differences in serious psychological distress or functional impairment account for racial/ethnic differences in perceived need for treatment.


Data from the 2009–2014 National Survey of Drug Use and Health, a survey of a nationally representative sample of the U.S. population, were analyzed. Logistic regression models were used to test whether differences in psychological distress, assessed with the Kessler-6, or functional impairment, assessed with the WHO Disability Assessment Scale, account for racial/ethnic differences in perceived need for mental health treatment.


Perceived need, psychological distress, and functional impairment all vary significantly across racial/ethnic groups; psychological distress is highest among Hispanics interviewed in English and lowest among Hispanics interviewed in Spanish, while functional impairment is highest among Non-Hispanic Whites and lowest among Hispanics interviewed in Spanish. Associations with perceived need vary across racial/ethnic groups for distress (X2 (5) = 22.14, p = .001), but not for impairment (X2 (5) = 8.73, p = .121). Associations between distress and perceived need are significantly weaker among Hispanics interviewed in Spanish than among Non-Hispanic Whites (OR = 1.13 vs. 1.08, p = .001). Differences across racial/ethnic groups in perceived need are sustained after adjustment for distress and impairment.


Differences in perceived need across racial/ethnic groups are not attributable to differences in distress and impairment. Heterogeneity in the relationships of psychological distress and functional impairment with perceived need for mental health treatment is related to language, a strong indicator of country of birth.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.