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Original research
Racial and ethnic trends in mental health service utilisation and perceived unmet need in the USA
  1. Ana Sheehan1,
  2. Rachel Walsh2,
  3. Richard Liu3,4,5
  1. 1 Department of Psychological, University of Delaware, Newark, Delaware, USA
  2. 2 Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
  3. 3 Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Stanley Center for Psychiatric Research, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
  1. Correspondence to Ana Sheehan, Department of Psychological, University of Delaware, Newark, DE 19716, USA; ansheeha{at}udel.edu

Abstract

Background Two decades ago, the Surgeon General issued a report highlighting concerning disparities in mental healthcare among racial and ethnic minority populations. The present study characterised national trends in mental health treatment utilisation by race and ethnicity across a 13-year period.

Methods Nationally representative data were drawn from the National Survey on Drug Use and Health from 2008 through 2020 (unweighted n=4 41 993). Trends in mental health treatment utilisation and perceived unmet treatment need among individuals with and without psychiatric illness were stratified by race and ethnicity.

Results Logistic regression analyses revealed most racial/ethnic minority groups were less likely to receive treatment than white individuals, regardless of mental health status. Treatment utilisation increased among those with (annual per cent change (APC)=0.83, 95% CI=0.41 to 1.26) and without psychiatric illness (APC=1.39, 95% CI=0.53 to 2.26). Among individuals with psychiatric illness, treatment use increased among white (APC=0.88, 95% CI=0.51 to 1.24), Hispanic (APC=2.12, 95% CI=0.70 to 3.57) and black adults (APC=1.07, 95% CI=0.11 to 2.04). White (APC=1.88, 95% CI=0.86 to 2.91) and Hispanic (APC=2.45, 95% CI=0.02 to 4.93) individuals without psychiatric illness also saw increased treatment use. Although increases in perceived unmet treatment need were observed for all racial and ethnic groups except blacks and Native Americans with psychiatric illness, rates remained low across all groups.

Conclusions Although national rates of mental health treatment utilisation have risen, this was almost entirely observed among white and Hispanic individuals with and without psychiatric illness, highlighting the limited progress made towards eliminating disparities in care.

  • MENTAL HEALTH
  • EPIDEMIOLOGY
  • HEALTHCARE DISPARITIES

Data availability statement

Data are available in a public, open access repository. The manuscript uses data from the National Survey on Drug Use and Health, conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA) for study years 2008 through 2020. Data can be found at https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2020-nsduh-2020-ds0001. All material appearing in this manuscript is in the public domain and may be reproduced or copied without permission from SAMHSA.

https://doi.org/10.1136/jech-2023-220683

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    Data availability statement

    Data are available in a public, open access repository. The manuscript uses data from the National Survey on Drug Use and Health, conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA) for study years 2008 through 2020. Data can be found at https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2020-nsduh-2020-ds0001. All material appearing in this manuscript is in the public domain and may be reproduced or copied without permission from SAMHSA.

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    Footnotes

    • Twitter @AnaSheehan19

    • Contributors AS: Guarantor. AS and RL: study conception and design. All authors: analysis and interpretation of results, draft manuscript preparation, reviewed the results and approved the final version of the manuscript.

    • Funding This research was supported by National Science Foundation Graduate Research Fellowships (AS and RW) along with the National Institute of Mental Health (grants RF1MH120830, R01MH101138, R01MH115905 and R21MH112055) (RL).

    • Competing interests RL serves as a consultant with Relmada Therapeutics and is on the advisory board for Launch2Life.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.