Data Finds Racial and Ethnic Disparities in Mental Health Diagnoses

Being diagnosed with anxiety or depression during a primary care visit may not only depend on your mental health status. A new analysis finds that there are large disparities in receiving a mental health diagnosis across races and ethnicities in the U.S.

An Athenahealth analysis of patient visits to primary care providers (PCPs) in 2020 found that although anxiety and depression are “strikingly common” in more than 24 million patients, the diagnosis of the conditions varied greatly between demographic groups.

Many experts say this data points to underlying disparities in mental health care in the U.S. After all, a patient is diagnosed with a disorder when they feel comfortable, or are able to, express their mental health symptoms with a PCP.

Overall, White patients were most likely to discuss their mental health with PCPs, and therefore receive a diagnosis if necessary, than those of all other racial groups. The gap for Asian patients was particularly wide—they were 227% and 213% less likely to be diagnosed with anxiety or depression, respectively, than White people.

"We cannot look at racial disparities without recognizing that the systems in our country were built to serve the white majority, and the healthcare system is no exception," Kelly Yang, BS, a medical student and research scholar at Albert Einstein College of Medicine in New York City, tells Verywell. She adds that factors like stigma and lack of Black, Indigenous, and people of color (BIPOC) healthcare professionals perpetuate these inequities.

How Race and Ethnicity Impact Your Health Care

The Athenahealth study tracked more than 24 million people over an 8-month period—between May and December of last year. Patients were considered to have anxiety or depression if at least one PCP visit led to a diagnosis. Demographic trends in diagnosis of depression and anxiety disorders included:

• Women were more than one and a half times as likely as men to be diagnosed with an anxiety disorder or major depression
• Patients between the ages of 51-70 were most likely to receive a diagnosis of anxiety
• Patients between the ages of 71-80 were most likely to receive a diagnosis of depression
• The more chronic health conditions you had, the more likely you were to be diagnosed with either disorder

The research was inspired by a survey report from the Center for Disease Control and Prevention (CDC) conducted in June 2020. The CDC found that U.S. adults were experiencing more anxiety and depression during the pandemic, with younger adults and Hispanic/Latino individuals feeling the brunt of it.

The trends in gender, age, and medical history can be at least partially explained by existing evidence. For example, women, in general, are more likely to talk about mental health problems with their PCP and seek help.

But the trends in race and ethnicity highlight barriers to care. In the study, White patients were significantly more likely to be diagnosed with either depression or anxiety than Black, Hispanic/Latino, and especially Asian patients.

Compared to Asian people, in particular, 7.2% and 4.7% of White patients were diagnosed with anxiety and depression, respectively. In comparison, Asian patients were only diagnosed at rates of 2.2% and 1.5%.

Disparities in Asian Mental Health Care

When considering these rates, some might assume Asian patients just don't struggle as much with depression and anxiety. But that is far from reality, Yang says.

In a 2019 study, Yang and colleagues found that although Asian and White people might perceive their need for mental health care at different rates, that does not explain the wide gap in who actually gets diagnosed and treated. Specifically:

• 87.1% of White respondents with perceived need for mental health care received it compared to 80% of Asians with a perceived need
• 53.3% of White people reporting serious psychological distress received mental health treatment compared to 28.9% of Asian people reporting the same distress
• 70% of White patients with a major depressive episode within the past year received mental health treatment compared to 35.3% of their Asian counterparts

Why are rates for Asian respondents consistently lower? Asian respondents cited "not knowing where to go" as a barrier for treatment as a barrier more frequently than did White individuals.

And while cost wasn't reported as a significant barrier to treatment, additional evidence suggests the contrary. "The steep cost of mental health care in the United States is still a challenge faced by many individuals seeking care, and one that disproportionately affects people of color, including Asian Americans," Yang adds.

"Much of the literature cites stigma as a big contributing factor for the disparity in mental health care," Yang adds. "While this is certainly a contributing factor, there are by far more systemic factors contributing to the lack of mental health treatment."

One Provider's Experience

Timothy Lo, LCSW, a psychotherapist in Chicago, says the Athenahealth report helps contextualize long-term problems. "The question is are Asian-Americans being diagnosed at a higher or lower rate based on them, or based on the system that they're part of?"

Lo says the answer is the latter. Yang's study, he adds, contextualizes the issues even further. "Part of it is simply utilization, that Asian-Americans are less likely to seek help despite knowing that it's there, despite needing it."

In general, this aligns with his anecdotal experience as a clinician. "In Asian populations, like most immigrant populations in the U.S., there is a greater stigma around accessing mental health services," he says. Among his Asian clients, he sees a lack of acknowledgment around the topic of mental health, particularly among immigrants who did not grow up in the U.S.

There can also be a language barrier, considering a minority of therapists speak Cantonese or Mandarin. "That has shown up for me multiple times, where folks have reached out to me because they're desperately trying to find a therapist for themselves or family members who actually want to utilize services, but their English isn't good enough," he says. "I can't speak [their language] nearly well enough to do clinical work."

And in general, of the Asian clients he does see, they tend to seek him out through insurance. People who don't have or can't afford insurance can't find help this way.

How to Address These Disparities

Mental health care in the U.S. has been and is unaccommodating of cultural or language differences, Yang says, because the majority of the mental health workforce is made up of White individuals.

But that doesn't mean it can't change. "The healthcare field is moving in the right direction in that cultural competence is now heavily emphasized, more individuals of racial/ethnic minority backgrounds are entering the mental health workforce, and efforts such as the All of Us project are underway to include more diverse samples of participants in research studies," Yang says. "However, we still have a long way to go before any form of equity can be reached."

When thinking about what needs to change to reduce disparities, Lo says it starts with access. Every single person who needs access to care should get it, removing all barriers including lack of multicultural providers, cost, scheduling, and location. "It would involve an enormous change in multiple ways across the entire mental health field," he says. It would also involve universal health care, he adds.

In an ideal world, Yang says, the U.S. would achieve mental health equity, not just equality, by establishing a system where everyone would get what they specifically need in order to live a healthy and fulfilling life. "This includes not just access to mental health care, but also to food, shelter, work, and other basic human needs that inevitably impact our mental health," she says.