Yirenya-Tawiah Abena, Cubbin Catherine
Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
J Racial Ethn Health Disparities. 2025 May 6. doi: 10.1007/s40615-025-02456-z.
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.
在获得和延迟的心理保健方面，种族/族裔差异持续存在，使边缘化人群的权利得不到保障。新冠疫情加剧了对改善心理健康服务和护理的未满足需求。我们使用安德森医疗保健利用模型，研究了在疫情期间美国成年人的全国代表性样本中，易患因素、促成因素和需求因素与心理保健利用之间的关联。
这项横断面研究使用了2021年全国健康访谈调查的横断面数据，采用安德森医疗保健利用框架（n = 19555），研究了寻求心理保健的行为。考虑到加权和复杂的样本设计，包括针对缺失数据的推算收入文件，我们估计了逻辑回归模型，以检验心理健康易患因素（年龄、性别、种族/族裔和婚姻状况）、促成因素（医疗保险状况、收入、教育程度和地理位置）以及心理健康需求因素（焦虑和抑郁症状）与前一年接受心理保健之间的调整后关联。
我们多变量逻辑回归模型的研究结果表明，在每个易患因素、促成因素和需求因素方面都存在显著的心理保健差异。在调整后的模型中，少数种族和族裔使用服务的几率明显低于非西班牙裔白人。
结果表明，需要改进政策和开展与文化相关的循证干预措施，以改善寻求心理健康的态度和整体护理，特别是针对服务不足的人群。迫切需要解决美国心理健康服务的可及性和障碍问题，重点关注种族和族裔如何与社会经济地位和地理位置等其他既定障碍相互交织。
