(211) Racial/ethnic differences in mental health service use and unmet need for treatment among US adults with a past-year major depressive episode in the 2020 National Survey on Drug Use and Health Data

Publication Number: 872

Background: Based on the 2020 National Survey on Drug Use and Health (NSDUH), an estimated 21 million adults in the US experienced at least one past-year major depressive episode (MDE). It is important to understand structural and perceptual barriers to depression treatment and differences by race/ethnicity to optimize patient outcomes and equitable treatment access.

Objectives: The objective was to examine racial/ethnic differences in mental health service use and perceived unmet need for mental health services among adults with a past-year MDE.

Methods: We utilized self-reported data from adult participants of the 2020 NSDUH, a population-based survey of the civilian non-institutionalized US population. The association of race/ethnicity with mental health service use and perceived need for mental health services that was not fulfilled among adults with a past-year MDE defined based on DSM-5 criteria was assessed using sampling weighted survey-logistic regression analysis adjusted for age, sex, education, marital status, and income.

Results: Among 26,017 participants, 2,898 (8.4%) met DSM-5 criteria for at least one MDE in the 12 months before the interview, 59.0% of whom sought mental health treatment. In analyses by race/ethnicity, Hispanic or Latino adults were less likely to seek mental health services compared to non-Hispanic White adults (adjusted OR: 0.50; 95% CI: 0.33, 0.76). A total of 40.7% and 44.4% of participants seeking or not seeking treatment, respectively, reported an unmet need for treatment in the past year. Compared to non-Hispanic White adults, Hispanic or Latino adults were more likely to report an unmet need for mental health services in unadjusted regression analysis (OR: 1.48; 95% CI: 1.03, 2.13) while no such association was observed for Black or African American adults (OR: 0.90; 95% CI: 0.47, 1.71). In fully adjusted models, the ORs for an unmet need for mental health services were 1.26 (95% CI: 0.85, 1.85) for Hispanic or Latino and 1.12 (95% CI: 0.59, 2.11) for Black or African American compared to non-Hispanic White adults. Concern about cost was the most frequent reason for not using mental health services reported by 42.9% of participants with an unmet need for treatment. Further, 28.8% of participants reported not knowing where to go and 26.7% believed they could handle problems without help.

Conclusions: Only just over half of participants with a past-year MDE sought mental health treatment. Hispanic or Latino adults were less likely to seek treatment compared to non-Hispanic White adults. Over 40% of participants with past-year MDE reported an unmet need for treatment with concerns about cost and not knowing where to go reported as the most frequent reasons for not using mental health services.