Black and Hispanic Patients Have Significant Barriers to Accessing Psychological Care Despite Continuously Held Private Insurance

While racial and ethnic disparities in health care, including in behavioral health disorders, are known, disparities during first-episode psychosis have not been fully explored.

Significantly lower access to psychological interventions were observed among individuals with first-episode psychosis (FEP) dependent on ethnicity despite continuous health insurance coverage. These results, from an observational cohort study, were published in JAMA Psychiatry.

The researchers from the University of Southern California, Los Angeles obtained medical and prescription claims through the Optum’s Clinformatics Data Mart Database, which contained data from private insurance claims covering 60 million individuals in the United States. Data from 2018 to 2020 were analyzed for FEP (including schizophrenia, bipolar or major depressive disorder with psychotic behavior, and delusional and other nonorganic disorders) among individuals aged 10-21 years (N=3017).

Among the patients, 21.3% were Black (53.3%) or Hispanic (46.7%) and 78.7% were White, 50.4% were men or boys, and the mean age was 17.2 (standard deviation [SD], 2.72) years.

Compared with White patients, Black individuals were more likely (c2, 13.2; P <.001) and Hispanic individuals less likely (c2, 36.4; P <.001) to receive an FEP diagnosis. Black patients were more likely to receive a diagnosis for schizophrenia compared with White patients (13.1% vs 8.5%; P =.005).

Most diagnoses occurred through the emergency department and did not differ on the basis of ethnicity (P =.24).

During the year after an FEP diagnosis, White patients were more likely to receive another behavioral health disorder diagnosis (76.1% vs 63.8%; c2, 39.3; P <.001), to visit an outpatient behavioral health professional (52.1% vs 36.1%; P <.001), to receive psychotherapy (47.9% vs 30.8%; P <.001), fill an antipsychotic prescription (24.4% vs 17.3%; P <.001), and receive a diagnosis from another health professional (42.2% vs 30.9%; P <.001).

Compared with White patients, Black and Hispanic patients were more likely to be in the lowest (20.1% vs 8.2%; P <.001) and less likely to be in the highest (20.1% vs 49.2%; P <.001) income categories.

This study may have been limited by some missing data, including geographical location. There may have been geographic-related disparities in access to health care professionals, however, the investigators were unable to correct for these factors.

These findings confirmed the previously identified disparities of ethnic-related psychological care among Americans. The ethnic-based differences remained significant even among individuals with continuously held private health care insurance and when corrected for household income.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Heun-Johnson H, Menchine M, Axeen S, et al. Association between race/ethnicity and disparities in health care use before first-episode psychosis among privately insured young patients. JAMA Psychiatry. Published online December 23, 2020. doi:10.1001/jamapsychiatry.2020.3995.