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


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.

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