Treatment-Seeking Disparity between African Americans and Whites: Attitudes toward Treatment, Coping Resources, and Racism

By Buser, Juleen K. | Journal of Multicultural Counseling and Development, April 2009 | Go to article overview

Treatment-Seeking Disparity between African Americans and Whites: Attitudes toward Treatment, Coping Resources, and Racism


Buser, Juleen K., Journal of Multicultural Counseling and Development


African Americans seek mental health treatment at lower rates than Whites. This disparity has been attributed to African Americans' attitudes toward services, alternate coping, and differences in care. Research on microaggressions adds an important element to this literature. Including discussion of microaggressions in counseling training may illuminate subtle student biases.

Los individuos Afroamericanos buscan recibir tratamientos de salud mental en un indice menor que los Blancos. Esta disparidad ha sido atribuida a las actitudes de los Afroamericanos hacia los servicios, formas de afrontamiento alternativas, y a las diferencias en la asistencia. Las investigaciones sobre microagresiones anaden un elemento importante a esta documentacion. Incluir la discusion sobre microagresiones en la formacion de consejeros puede iluminar los sesgos sutiles de los estudiantes.

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Despite studies indicating that African Americans struggle with mental illness and may deal with more persistent mental health issues than Whites (Breslau, Kendler, Su, Gaxiola-Aguilar, & Kessler, 2005; Kessler et al., 1994; Robins & Regier, 1991), African Americans seek treatment at lower rates than Whites do (Angold et al., 2002; Kearney, Draper, & Baron, 2005; Song, Sands, & Wong, 2004). This treatment-seeking disparity is often explained through an emphasis on African Americans' attitudes toward mental health service, coping resources in the African American community, and forms of racial bias in mental health care (Breland-Noble, Bell, & Nicolas, 2006; Snowden, 2003). Much of the research on the treatment-seeking disparity does not emphasize subtle forms of racism in mental health treatment. However, literature has also focused on aversive racism--such as microaggressions---in mental health professions (e.g., Constantine & Sue, 2007; Sue et al., 2007; Sue, Nadal, et al., 2008). This research adds a crucial element in explaining African Americans' hesitancy to seek mental health care (Constantine, 2007).

In this review, I underscore literature on the stigma associated with seeking mental health services in the African American community, coping resources often used by African Americans, and racial differences in mental health care. Although it is imperative to consider these reasons, they alone cannot explain the discrepant treatment-seeking rates. I also review emerging research on microaggressions in the therapeutic encounter to explain African American hesitancy to pursue care. Ultimately, these findings reveal the obvious and insidious ways in which racism continues to persist and present a call to counselors to address these realities in practice and training.

mental illness rates

Comparisons of physical disease among racial groups have garnered more research attention than investigations of mental illness differences (Breslau et al., 2005). However, a body of research has examined mental illness rates in the African American community (Breslau et al., 2005; Kessler et al., 1994; Robins & Regier, 1991).

The Epidemiologic Catchment Area Study was conducted in the 1980s and included 4,638 African American, 12,944 White, and 1,600 Hispanic samples taken from the general community and from institutions (Robins & Regier, 1991; U.S. Department of Health and Human Services, 2001). The Epidemiologic Catchment Area Study found that African Americans had a higher lifetime prevalence of mental disorders, but this difference disappeared after accounting for demographics and socioeconomic status (SES [Robins & Regier, 1991; U.S. Department of Health and Human Services, 2001]). However, African Americans were found to have twice the lifetime prevalence of agoraphobia and phobia when compared with Whites (Kessler et al., 1994; Robins & Regier, 1991).

The National Comorbidity Survey (NCS) was conducted in the early 1990s with a stratified sample of 8,098 U. …

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