Ethnic Inequalities in Mental Illness Diagnosis and Satisfaction with Healthcare Access

Abstract

Persistent ethnic inequalities in health are an important concern in New Zealand. In order to better understand this inequality, the current thesis presents two manuscripts that examine ethnic disparities in mental health outcomes and healthcare access using a nationally representative sample of New Zealanders. In the first manuscript, I assessed ethnic differences in the diagnosis of depression or anxiety disorders by a doctor in the past five years, relative to self-reported scores on a screening measure for non-specific psychological distress. Compared to Europeans/Pākehā, those of Māori, Pacific, or Asian ethnicity showed a higher rate of high psychological distress but a lower rate of diagnosed mental illness. According to Signal Detection Theory (SDT), our results demonstrate that the mental health problems of ethnic minorities are more likely to be ‘missed’ (i.e. under-diagnosed). Extending on ethnic group disparities in health, the second manuscript investigated group differences in satisfaction with healthcare access. Ethnic minorities had lower satisfaction with their access to healthcare than Europeans/Pākehā. These results may shed light on the lower rate of mental illness diagnosis among ethnic minorities, suggesting this may be due to insufficient healthcare access. Additionally, my second manuscript identified various demographic and psychological correlates of people’s satisfaction with their healthcare access. Together, these findings help clarify ethnic inconsistences in mental health outcomes and extend the literature regarding healthcare inequalities experienced by different ethnic groups in New Zealand. These results provide an important framework for future research on barriers to healthcare access and inform the development of future healthcare interventions that aim to achieve a more equitable healthcare system.