Sociodemographic Disparities in Mental Health Care Settings Among Adults

Untreated mental illness has significant consequences for both society and individuals, yet sociodemographic disparities in mental health care persist. Given the barriers to mental health care that rural and racially marginalized populations face, understanding mental health treatment settings across these populations may help catalyze future actions tailored to these settings. This study aimed to analyze rural-urban and racial-ethnic disparities across mental health care settings.

This cross-sectional study examined 92,639 adult respondents to the National Survey on Drug Use and Health (2021 and 2022). Rural-urban and racial-ethnic disparities in receipt of mental health care in the past 12 months were evaluated by using Rao-Scott chi-square tests and multivariable logistic regressions. All analyses used complex survey weights.

In 2021-2022, no rural-urban differences were found among respondents receiving inpatient or outpatient care. Compared with respondents in large metro areas (classified by the 2013 Rural-Urban Continuum Codes), nonmetro respondents were less likely to use virtual care (i.e., telehealth; adjusted odds ratio=0.74, 95% CI=0.65-0.86). Non-Hispanic White respondents were more likely than non-Hispanic Black respondents to receive outpatient care, prescription medication, and telehealth, whereas non-Hispanic Black respondents were more likely than Non-Hispanic White respondents to receive inpatient care.

Widespread telehealth uptake after 2020 did not equally increase access to telehealth care for all rural-urban classifications. Racial and ethnic disparities were striking; initiatives that prioritize cultural competence and promote racial-ethnic equity in mental health care should be supported.