The Role of Depression on Medical Mistrust and Mental Health Service Use in Black Adults

Major depressive disorders are ranked third in the global burden of disease by the World Health Organization. The association between mistrust in Black adults and its effect on health service utilization is well established. However, research on mistrust and specific utilization of mental health services is limited. This study examines role of depression in the association between mistrust and mental health service utilization. We conducted an online cross-sectional survey among Black adults (n = 1042) using the Group-Based Medical Mistrust Scale, the General Help-Seeking Questionnaire, and the Patient Health Questionnaire-9. Ordinal logistic regression models were used to assess the relationship between medical mistrust and its association with willingness to use mental health services. We added depressive symptoms to the model to assess how depressive symptoms may impact the primary association. Black adults with moderate levels of mistrust reported increasing levels of willingness to seek help compared to the lowest levels of mistrust (Quartile 2: OR = 3.73; 95% CI 2.69, 5.19; p < 0.001 and Quartile 3: OR = 5.02; 95%CI 3.60, 6.99; p < 0.001), whereas Black adults at the highest level of mistrust were less likely to seek help from a mental health professional than quartiles 2 and 3 (Quartile 4 OR = 2.38; 95%CI = 1.75, 3.25; p < 0.001) in a model that adjusted for age, sex, and education. The inclusion of depressive symptoms in the model resulted in a 25.7% average decrease in willingness to seek help from a mental health professional. Depressive symptoms may have an impact on the effect of medical mistrust and its association with willingness to seek mental health services for Black adults. Interventions designed to increase service utilization and engagement should consider the role of medical mistrust and the role of depressive symptoms.