Mental health status and the utilization of mental health services among immigrant women ages 50 and above living in the US
Background: Because immigration is a stressful life event accompanied by acculturation pressure in a new country, it inevitably influences the mental health of immigrants. Thus, the goal of this dissertation is to investigate the mental health status and utilization of professional mental health services among immigrant women at least 50 years of age and to identify barriers and protective factors associated with mental disorders and access to mental health services. Method: This secondary cross-sectional study utilizing the National Institute of Mental Health Collaborative Psychiatric Epidemiology Survey (CPES), which comprises three nationally representative surveys conducted between 2001 and 2003 including the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and the National Latino and Asian American Survey (NLAAS). The information on county-level characteristics was derived from the 2000 U.S. Census data. Descriptive, bivariate, and multivariable analyses, including multilevel modeling, were performed. Result: Twenty-seven percent of all immigrant women ages 50 and older met the criteria for a diagnosable psychiatric disorder. Compared to Black immigrant women, Latinas were more likely to have anxiety and mood disorders. Both Asian and Latina women demonstrated a higher probability of seriously considering suicide than Black women. Among those with a diagnosable mental health condition, successfully accessing professional mental health services was positively associated with younger age, being Latina, more frequent communication with others about their problems, and being covered by health insurance. Asian women living in the US who perceived themselves as having a high social status were more likely to use professional mental health services than Asian women who considered themselves to be of a lower social status. Although aggregated county-level characteristics explained 2% of the variance for experiencing mental disorders in the empty model, the county-level socioeconomic disadvantages, racial density and residential mobility, were not significantly associated with any mental disorder. Conclusion: Racial disparities exist in four mental disorders among middle and older immigrant women in the US. Women of older age and Asian ethnicity were less likely to utilize professional mental health services. The primary factors that enabled aging immigrant women with mental disorders to obtain professional mental health services were insurance status and effective communication about problems in daily life. Therefore, increasing insurance coverage, and improving the quality of medical care are strategies that should be considered for future policies aiming to address the underutilization of mental health services among aging immigrant women with mental disorders.