Racial and Ethnic Disparities in Mental Health Service Utilization During COVID-19

Racial/ethnic disparities in access to and delayed mental healthcare persist and disenfranchise marginalized populations. The COVID-19 pandemic exacerbated unmet needs for improved mental health services and care. Using the Andersen's model of healthcare utilization, we examined associations between predisposing, enabling, and need factors on mental healthcare utilization among a nationally representative sample of US adults during the pandemic.

This cross-sectional study examined mental healthcare seeking behaviors using cross-sectional data from the 2021 National Health Interview Survey using Andersen's healthcare utilization framework (n = 19,555). Accounting for weighting and the complex sample design, including imputed income files for missing data, we estimated logistic regression models to examine adjusted associations between mental health predisposing (age, gender, race/ethnicity, and marital status), enabling, (health insurance status, income, education, and geographic location), and mental health need (anxiety and depression symptoms) factors and receiving mental healthcare in the prior year.

Our findings from multivariate logistic regression models indicated significant mental healthcare disparities in every predisposing, enabling, and need factor. In adjusted models, racial and ethnic minorities used services at significantly lower odds than non-Hispanic Whites.

The results suggest the need for improved policies and culturally relevant evidence-based interventions in improving mental health seeking attitudes and overall care, specifically for underserved populations. There is a dire need to address access and barriers to mental health services in the US with a focus on how race and ethnicity intersect with other established barriers such as socioeconomic status and geography.